Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence.

Perineal scanning using linear array ultrasound was used as an alternative to radiologic cystourethrography in the investigation of female urinary incontinence. The technique provides similar information to that obtained by fluoroscopy without exposing the patient and the physician to radiation. The bladder neck and urethra as well as the urodynamic catheter are readily visualized. Familiarity with the unusual configuration of the sonogram needs to be attained.

A prospective study of the accuracy of ultrasound in predicting fetal microcephaly.

A prospective study of the diagnostic accuracy of ultrasound in the prediction of fetal microcephaly was performed on a study population of 24 patients. An occipitofrontal diameter larger than the predicted mean -2 standard deviations (SD), a head perimeter larger than the predicted mean -2 SD, and a head perimeter/abdominal perimeter larger than the predicted mean -1 SD were found to exclude fetal microcephaly. An occipitofrontal diameter smaller than the predicted mean -4 SD, a head perimeter smaller than the predicted mean -5 SD, a head perimeter/abdominal perimeter smaller than the predicted mean -3 SD, and a femur length/head perimeter larger than the predicted mean +3 SD were found to cause no errors in the diagnosis of microcephaly. If neither of these two groups of tests is satisfied, fetal microcephaly cannot be reliably diagnosed or excluded on the basis of a single ultrasound examination.

Sonographically monitored amniocentesis to decrease intraoperative complications.

The rates of intraoperative complications (dry and bloody taps) of two amniocentesis techniques were compared in 1300 patients undergoing second trimester procedures for genetic indications. The sonographically guided technique consisted of the selection of a site for needle insertion with ultrasound, removal of the transducer, and immediate amniocentesis. The sonographically monitored technique consisted of the continuous visualization of the needle during the entire procedure. Six hundred twelve amniocenteses were performed with the sonographically guided technique and 688 with the sonographically monitored technique. There was a statistically significant decrease in the incidence of bloody and dry taps of the first needle insertion (relative risk = 38%, P less than .0001) and also in the number of patients that required multiple needle insertions (relative risk = 42%, P less than .0001) with the sonographically monitored technique.

Value of culdocentesis in the diagnosis of ectopic pregnancy.

The diagnostic value of culdocentesis was examined in all patients admitted with hemoperitoneum during a three-year period. There was a total of 158 women with positive culdocentesis, of whom 132 (83.5%) had tubal ectopic pregnancies and 26 had other diagnoses. Of the 132 patients with ectopic gestations, the majority (62%) had unruptured tubes. A nondiagnostic culdocentesis should not be used either to raise or to lower the clinician's suspicion of ectopic pregnancy as 16% of patients with an ectopic pregnancy had a nondiagnostic culdocentesis, of which one-quarter were ruptured and three-quarters had hemoperitoneum diagnosed at the time of surgery. A positive culdocentesis along with a positive serum human chorionic assay was associated with an ectopic pregnancy in 99.2% of cases. This procedure should not be limited to the evaluation of patients with classic peritoneal signs, as 45% of the authors' patients with a positive culdocentesis did not have such findings.

Diagnosis of ectopic pregnancy: value of the discriminatory human chorionic gonadotropin zone.

A prospective study was conducted to test the hypothesis that the absence of an intrauterine gestational sac when the serum level of human chorionic gonadotropin (hCG) is above 6500 mIU/mL is indicative of ectopic pregnancy. A total of 383 patients who were clinically suspected to have ectopic pregnancies had pelvic ultrasound examinations with serum hCG determinations on the day of the scan. There were 217 (57%) intrauterine gestations, 104 (27%) ectopic pregnancies, and 62 (16%) spontaneous abortions. Forty-one percent of patients had an hCG level above 6500 mIU/mL. The absence of an intrauterine gestational sac at an hCG concentration above this level had a sensitivity of 100%, a specificity of 96%, a positive predictive value of 86%, a negative predictive value of 100%, and was 98% efficient, based on a 19.4% prevalence of ectopic pregnancies among this group.

Pergolide therapy in Parkinson's disease.

A total of 26 patients were treated with pergolide mesylate, a semi-synthetic ergot derivative with the property of direct dopamine activity. Of these patients, 18 suffered from late failure of L-dopa, while the remaining 8 had never before been treated with L-dopa. The aim of the trial was to study the activity of pergolide, either by giving it to untreated patients or by reducing as much as possible the L-dopa given in patients with parkinsonism. Adverse effects and failure rate were reduced by slowly increasing the daily dosage, by giving considerable dose flexibility whenever side-effects were manifest, and by the use of relatively low doses (mean of 3.8 mg in the L-dopa-group and 2.9 in the other group). At present, from 26 patients, 13 (50%) still remain in the study for an average treatment period of 16 months (3 weeks to 25 months for the group as a whole). All patients experienced a beneficial effect from pergolide, especially during the first months of treatment, in selfcare, rigidity, gait and automatic movements. Slight or no improvement was seen in tremor, speech and posture. The most frequent side-effects were nausea and vomiting (in the initial phase of the treatment), insomnia and psychotoxic reactions (mostly periods of confusion accompanied by visual hallucinations and paranoid illusions). The study indicated that pergolide mesylate is a useful additive for treatment of parkinsonism, but special attention should be paid to the important psychotoxic adverse effects that may appear, even at a low dose.

Fetal skeletal anomalies.

Skeletal dysplasias are a heterogeneous group of disorders of bone growth resulting in abnormal shape and size of the skeleton. The prenatal diagnosis of these disorders is a particularly challenging task. This article reviews the birth prevalence and classification of skeletal dysplasias and provides an approach to the diagnosis of conditions identifiable at birth.

Automatic segmentation of ultrasound images using morphological operators.

A method for the automatic measurement of femur length in fetal ultrasound images is presented. Fetal femur length measurements are used to estimate gestational age by comparing the measurement to a typical growth chart. Using a real-time ultrasound system, sonographers currently indicate the femur endpoints on the ultrasound display station with a mouse-like device. The measurements are subjective, and have been proven to be inconsistent. The automatic approach described exploits prior knowledge of the general range of femoral size and shape by using morphological operators, which process images based on shape characteristics. Morphological operators are used first to remove the background (noise) from the image, next to refine the shape of the femur and remove spurious artifacts, and finally to produce a single pixel-wide skeleton of the femur. The skeleton endpoints are assumed to be the femur endpoints. The length of the femur is calculated as the distance between those endpoints. A comparison of the measurements obtained with the manual and with the automated techniques is included.

Antenatal diagnosis and obstetric management of Dandy-Walker syndrome.

Real-time ultrasound equipment has the potential for investigating the fetal neural axis and allows the diagnosis of many anomalies arising from this area. Five cases of Dandy-Walker syndrome, one of the major causes of congenital hydrocephalus, were diagnosed antenatally. In all cases ultrasound allowed specific recognition of the defect in the cerebellar vermis. This defect connected the fourth ventricle to a posterior fossa cyst in four cases and to an occipital meningocele in one case. In three cases the diagnosis was made prior to viability, and the parents elected termination of pregnancy. In two cases recognized in the third trimester, neurosurgical care was provided soon after delivery.

[Complementarity and limits of the different technics of pancreatic morphologic investigation for the diagnosis of acute pancreatitis and complications (author's transl)]. / Complémentarité et limites des différentes méthodes d'investigation morphologique dans le diagnostic des pancréatites aiguës et de leurs complications.

The authors have previously proposed the endoscopic retrograde cholangio-pancreatography as a technic to be used systematically in acute pancreatitis; it offers a precise diagnosis of microlithiasis and a possibility of an immediate endoscopic treatment. They have studied the pancreatographic patterns in 355 cases of clinical acute pancreatitis; the pancreatogramm allows the diagnosis of chronic pancreatitis in acute phase in 1/3 of the patients; necrosis is present in 12% of the 240 patients without any radiological signs of chronic pancreatic disease. The computerized axial tomography gives a precise definition of the extra-pancreatic extension of the necrosis; the ultra-sound technic is better for the late complications of acute pancreatitis. The authors consider that these 3 examination technics must be performed at the admission or/and be part of the workup before surgery.

Intrathoracic fluid may be a normal finding at around 8 gestational weeks.

OBJECTIVE: To describe the observation of embryonic thoracic fluid at around 8 weeks' gestation and to discuss the likely etiology. METHODS: This was a retrospective study of patients referred between August 2005 and May 2006 to our units in France and in the USA for a dating scan between 6 and 10 weeks. Included in our series were all embryos presenting with an ultrasound finding suggestive of an early pericardial fluid collection, i.e. a large anechoic fluid collection surrounding the heart. The gestational age, fetal heart rate and maternal age at this first scan were recorded, along with nuchal translucency thickness as measured at the 12-week scan and the second-trimester anomaly scan results. RESULTS: Five cases were included in this study. In all five patients, the anechoic fluid collection was visualized at 8 weeks, and by the time of the nuchal scan it had disappeared completely. The nuchal translucency thickness was normal in all cases and all five embryos had normal cardiac examinations during the second trimester and were normal at birth. CONCLUSIONS: The observation on ultrasound at 8 weeks' gestation of a large anechoic fluid collection surrounding the heart that disappears by week 12 is suggestive of a transient pericardial collection.

Persistent right umbilical vein: an ominous prenatal finding?

The persistence of a right umbilical vein is an uncommon finding, with only a dozen cases reported since 1826. The persistent right umbilical vein may replace the normal left umbilical vein or be supernumerary. The anomaly is associated with numerous and occasionally lethal malformations. In this series, only three of six fetuses (and another two in the literature) had no associated anomalies. All the others had a variety of associated lesions ranging from minor to lethal. The appearance at ultrasound is easy to recognize: The intrahepatic portion of the umbilical vein is lateral to the gallbladder, and the portal vein curves toward the stomach, instead of parallel to it. Since the recognition of the persistent right umbilical vein is simple and does not require additional scanning (it is visible in the section used to measure the abdominal perimeter), the author suggests using it as an indicator for more in-depth scanning.

Prenatal detection of simian crease.

We present the prenatal detection of a simian crease (transverse palmar line) in seven fetuses. Three fetuses had trisomy 21, four had normal chromosomes but another anomaly (meningomyelocele, thanatophoric dysplasia, achondroplasia [2]). The technique used and normal anatomy are described.