Role of transvaginal sonography in the detection of endometriomata.

Endometriosis is a common cause of pelvic pain and infertility in young women. Transvaginal sonography is major means for diagnosing ovarian In our study, we scanned 60 patients with endometriomata who underwent laparotomy or laparoscopy. We compared preoperative ultrasonographic diagnosis with histological reports. The sonographic criteria for the diagnosis of endometriomata were (1) cystic structure with low, homogeneous echogenicity and (2) thick cystic wall with regular margins. In 50 patients, sonography suggested an endometrioma. In 47 cases, the diagnosis was correct. The false-positive cases were all caused by cystic teratomas with a homogeneous sonographic pattern. Ten false-negative cases were diagnosed by ultra-sonography as functional ovarian cysts (5), teratomas (3), and benign ovarian cystoma (1). Only 1 case of a 5-mm endometrioma was demonstrated by laparoscopy but not by TVS. The sensitivity of TVS for diagnosing endometriomata was 82.4% and specificity 97.7%; the positive and negative predictive values were 94% and 92.8%, respectively. The diagnostic accuracy of TVS was 93%. In our experience, TVS is a very specific means for diagnosing endometriomata when the typical pattern is detected; however, the sensitivity of the technique needs to be improved.

A new technique to test tubal patency under transvaginal sonographic control.

OBJECTIVE: Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency. MATERIALS AND METHODS: A detailed description of the technique is given. Two hundred and seventy-three patients underwent sonosalpingography in our department in the period 1990-1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy. RESULTS: Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated. CONCLUSION: Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.

Transvaginal sonography in the diagnosis of pelvic malignant recurrence: integration of sonography and needle-guided biopsy.

The aim of this study was to evaluate the efficiency of transvaginal sonography and sonography plus needle biopsy in detecting pelvic malignant recurrence. We scanned 24 patients already treated for gynecological malignancy, 21 of whom underwent needle biopsy under sonographic guidance. Thirteen patients were affected by cervical cancer, ten by ovarian cancer, and one by endometrial-ovarian carcinoma. Sonography detected 16 solid or cystic-solid masses (median size 52 mm, range 15-85 mm), one case of ascites, and one liquid mass (hematoma). All the patients in whom a suspicious mass was detected had recurrence. In the six patients in whom no mass was visible, two had recurrence. Needle biopsy was able to demonstrate recurrence in 17 patients (also in two false-negative scans). In one, even though sonography detected a mass, the histological sample was negative, but recurrence was later diagnosed by laparotomy.Accuracy, sensitivity and specificity of transvaginal sonography were respectively 91.6%, 89.4% and 100%. The positive predictive value was 100% and the negative predictive value was 71.4%. Transvaginal sonography was shown to be a useful means of detecting pelvic recurrence.

[New aspects concerning the corpus luteum]. / Nuovi aspetti riguardanti il corpo luteo.

We have summed up current knowledge about the formation and lysis of corpus luteum with the co-ordinate intervention of luteotrophic and luteolytic factors. Then we re-examined the function of the corpus luteum in the physiologic menstrual cycle and in the first period of pregnancy, with special attention to luteal insufficiency as a cause of endocrine miscarriage.

[Transcervical vs. transabdominal amniocentesis in the bacterial evaluation of the amniotic fluid]. / L'amniocentesi per via trans-cervicale versus l'amniocentesi per via trans-addominale nella valutazione batteriologica del liquido amniotico.

The authors compare the results of bacteriological research on amniotic fluid by transcervical and trans-abdominal amniocentesis. Eighty women at term of their pregnancy, scheduled for cesarean section, underwent a bacteriological vaginal test and a trans-cervical amniocentesis before and a trans-abdominal amniocentesis during cesarean section. The results obtained from both specimens of the amniotic fluid were the same in 90% of the cases. A negative bacteriological result of trans-cervical amniocentesis excluded a positive result of trans-abdominal amniocentesis. Instead, when a positive bacteriological result was obtained in trans-cervical amniocentesis, trans-abdominal amniocentesis gave a positive result in only 60% of the cases. We conclude that trans-cervical amniocentesis, besides being less dangerous, easy to perform and easily repeated, is sufficiently secure and reliable in bacteriological results as compared with trans-abdominal amniocentesis.

Transvaginal salpingo-sonography (TSSG) in the evaluation of tubal patency.

Transvaginal sonography was used in 78 patients to evaluate tubal patency as a control in infertility workup. The cervix was fitted with a Semm cervix-adapter (Wisap); air and saline were injected through it. Careful scanning of the uterine angles and of the tubes permitted to demonstrate bilateral passage of the contrast medium in 52 of the 55 patients and monolateral passage in 3. 21 patients had also other conventional evaluations of tubal patency. Two patients were excluded from protocol. Total agreement with hysterosalpingography (HSG) was found in 69.2% of the cases, partial agreement in 23%. Total agreement with laparoscopy (LPS) was found in 83.3% of the cases. In conclusion transvaginal sonosalpingography (TSSG) can be used as a first ambulatorial evaluation of tubal patency in infertility work-up.

[Variations in ferritin levels in blood during physiological pregnancy]. / Variazione dei livelli di ferritinemia nella gravidanza fisiologica.

Iron deficiency anemia is the most frequent haematological pathology in pregnancy. Serum ferritin levels represent the state of iron deposits. Low levels are a sure sign of iron deficiency. At the University of Turin we studied the variations of serum ferritin levels during physiological pregnancy and the sensitivity of routine blood tests with respect to serum ferritin levels. Routine haematological blood values along with ferritin levels were measured in 115 patients throughout pregnancy. The mean serum ferritin level was 56 ng/ml in the first trimester, 27.2 ng/ml in the second and 11.8 ng/ml in the third. The incidences of anemia per trimester was 6.6%, 4.8% and 49% respectively (p less than 0.05, chi squared). Our results show that it is important to evaluate iron deposits early in pregnancy by measuring serum ferritin levels in order to determine the need for iron therapy.

Pelvic mass biopsy by operative transvaginal sonography (OTVS).

Operative transvaginal sonography (OTVS) is widely used in clinical Obstetrics and Gynecology, however it has no definite role in Gynecologic Oncology. Between January 1990 and February 1991, we performed 18 ultrasonically-guided biopsies on suspected pelvic malignancies. The aim of our work was to assess to efficiency of OTVS in imaging, evaluating and biopsying pelvic masses. Fifteen patients had already been treated for gynecological malignancy, 3 were at their first evaluation. We used a Bruel & Kjaer mechanical transducer (7.5 MHz, type 8538). Biopsy needles were Menghini type (Surecut) 23 cm long, 16 or 18 G. The paper describes the results of the 18 biopsies. One false negative histological evaluation and one inadequate sample were obtained. No complications were observed. From our preliminary data, ultrasound-guided transvaginal scans may be usefully used in imaging and biopsying pelvic masses. It is a safe technique, easy to perform and well accepted by the patients.