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Biomedical subjects

A C Fleischer

Publications and source records attributed to A C Fleischer.

At least 19 recordsLinked to original sources
PubMed1996

Early detection of ovarian carcinoma with transvaginal color Doppler ultrasonography.

OBJECTIVE: Our purpose was to assess the potentials and limitations of the early detection of ovarian cancer in protocols that involve transvaginal color Doppler ultrasonography. STUDY DESIGN: Retrospective analysis was performed on the data from 206 referred patients who either had surgical or clinical follow-up of ovarian masses evaluated by transvaginal color Doppler ultrasonography. Most of the patients were referrals or had risk factors. RESULTS: In this series of 206 patients, 26 ovarian cancers were detected, > 70% of which were stage I or II. CONCLUSION: Transvaginal color Doppler ultrasonography is capable of early detection of ovarian carcinoma. An improved detection rate may be realized with better identification of high-risk patients who should be studied with transvaginal color Doppler ultrasonography.

Adolescent↗
PubMed1995

Serial assessment of adnexal masses with transvaginal color Doppler sonography.

Transvaginal color Doppler sonography (TV-CDS) was performed on 64 women with adnexal masses at 3, 6 and 12 weeks after initial presentation. In 47 (72% of patients studied), the pelvic mass demonstrated a decrease in size and increase in pulsatility index (PI) after 12 weeks. Of the patients undergoing surgery in this group, one had a tubo-ovarian abscess, one diverticular abscess and one hydrosalpinx. In seven patients (10%), there was no change in size or PI. Three in this group had an endometrioma, whereas two had a peritoneal cyst. In five (7%), there was no change in size and an increase in PI. One of these patients had a mucinous cystadenoma. In three (5%), there was a decrease in size and PI. Two of these patients had a tubo-ovarian abscess. In two (3%) patients studied, the mass showed an increase in size and decrease in PI; both had corpora luteum cysts with acute hemorrhage. Seventy-two percent of masses with high impedance underwent regression, whereas only 21% of lesions with low impedance did. Only 20% of masses demonstrating low impedance or morphologically complex structure regressed. Sixty-five percent of lesions that regressed had a significant drop in PI, whereas all the lesions that showed no change in size or enlargement had either no change or decrease in PI. Probability of regression was the greatest in young women (less than 40 years of age) and in masses < 5 cm. Ninety-three percent of women with persistent masses that underwent progestational suppression demonstrated regression with decrease of PI and peak systolic velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Abscess↗
PubMed1995

Sonohysterography: a technique for endometrial evaluation.

Sonohysterography involves the instillation of sterile saline under continuous sonographic visualization to assess the endometrial cavity. The technique is most useful for evaluating women with fertility problems, postmenopausal bleeding, or an abnormal endometrial interface as seen at baseline sonography. The procedure is performed with saline instilled into the endometrial cavity through a 5-F pediatric feeding tube or a hysterosalpingography or insemination catheter. In the normal uterus, the endometrium appears symmetric, surrounding the anechoic, saline-distended endometrial cavity. Adhesions appear as bridging bands of tissue that distort the uterine cavity or as very thin, undulating membranes, best seen at real-time examination. An intracavitary polyp is seen surrounded by anechoic fluid, with the point of attachment and thickness of the stalk clearly demonstrated. The location of leiomyomas can be determined: Intramural lesions do not distort the endometrial cavity, whereas submucosal lesions often do, with the overlying normal layer of endometrium clearly seen. In women with abnormal bleeding, focal areas of asymmetric endometrial thickening can be identified. Sonohysterography allows differentiation of intracavitary, endometrial, and submucosal abnormalities without the use of ionizing radiation or contrast agents.

Adult↗
PubMed1995

Pelvic sonogram.

Explore the source record for details and available documents.

Female↗
PubMed1995

Transrectal and transperineal sonography during guided intrauterine procedures.

Transrectal sonography was used to provide intraoperative guidance for dilatation and curettage and placement of intrauterine tandem apparatus in 20 patients in whom the external cervical os could not be visualized adequately. Transrectal sonography was found to be useful in providing guidance for these procedures and at the same time helped avoid uterine perforation. This method also was used during cerclage placement in two patients who had undergone several conizations. Transperineal sonography was used in three patients whose area of abnormality was best approached transperineally. These cases included transvaginal biopsy of a metastatic trophoblastic tumor and one guided aspiration of a perirectal abscess after pelvic exenteration. The potential advantages and pitfalls in the intraoperative use of transrectal and transperineal sonography for guided intrauterine procedures are discussed and illustrated.

Abscess↗
PubMed1995

Color Doppler sonography of adnexal torsion.

The purpose of this study was to describe the color Doppler sonographic findings in adnexal torsion that distinguish viable from nonviable ovaries. We present the color Doppler sonographic features in 13 patients with surgically proved adnexal torsion that help determine whether or not the ovaries were viable or nonviable at the time of surgery. Eleven combined ovarian and tubal torsions and two isolated tubal torsions were studied. In 10 cases the ovaries were considered nonviable at the time of surgery and in three cases they were considered viable. Of the nonviable group, six showed absent arterial and venous flow centrally, but two had low velocity (< 5 cm/s) arterial flow peripherally in the region of the adnexal branch of the uterine artery or in the main ovarian artery, and two demonstrated absent or reversed diastolic arterial flow. None of the nonviable ovaries showed venous flow centrally. In contrast, all of the viable ovaries demonstrated venous flow centrally, and two had peripheral and central arterial flow. Although the CDS findings in adnexal torsion are variable, ovarian viability may be predicted if central venous flow is present.

Adolescent↗
PubMed1993

Color Doppler sonography of ovarian masses: a multiparameter analysis.

This study analyzed vessel location, maximum systolic velocity, impedance, and waveform shape in 25 benign and 25 malignant surgically excised and pathologically examined ovarian masses as depicted by transvaginal or transabdominal color Doppler sonography, or both. Those parameters that achieved statistical significance (P > 0.05) between the two types of masses included vessel location, impedance, and waveform shape. Malignant masses typically were characterized by centrally located vessels that had low impedance without a diastolic "notch" in the waveform. Maximum systolic velocities are statistically similar in benign and malignant lesions. Multiparameter analysis may improve the diagnostic specificity and sensitivity of this technique in distinguishing benign from malignant ovarian masses.

Arteries↗
PubMed1993

Conventional and color Doppler transvaginal sonography of pelvic masses: a comparison of relative histologic specificities.

The relative specificity of CDS versus conventional TVS was assessed in 96 women with surgically excised and pathologically examined pelvic masses. In general, CDS was more specific than TVS in 43% of cases, both were equally specific in 41%, neither was more specific in 10%, and TVS was more specific than CDS in 6%. In particular, CDS seemed to be most specific in detecting ovarian malignancies, ovarian torsion, and ectopic pregnancy. The positive and negative predictive values of CDS were higher in postmenopausal women than in premenopausal women. The use of CDS as an adjunct to TVS is supported by the data from this study.

Adolescent↗
PubMed1992

Transvaginal color Doppler sonography and CA-125 elevation in a patient with ovarian thecoma and ascites.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.

Aged↗
PubMed1992

Color Doppler sonography of benign and malignant ovarian masses.

The use of transvaginal and transabdominal color Doppler sonography for the assessment of ovarian tumor vascularity was investigated in 62 cases of surgically excised and histologically examined ovarian masses. The modality was used to differentiate tumor neovascularity from normal arterioles (which contain smooth muscle in their media) on the basis of differences in the pulsatility observed in Doppler waveforms. Of the 25 malignant tumors in the series, 20 had low-impedance flow (pulsatility index of less than 1.0), and none had the diastolic notch seen in vessels in normal tissue. Three benign lesions, including two dermoid cysts and one tubo-ovarian abscess, also had low-impedance flow. The negative predictive value of color Doppler sonography was 98%, whereas the positive predictive value was 83%. Color Doppler sonography seems to be accurate for excluding malignancy, but some misdiagnosis may occur in cases of inflammatory and metabolically active benign masses.

Female↗
PubMed1992

Cervical pregnancy. A case report.

A cervical pregnancy was treated successfully with systemic methotrexate and folic acid. Serial beta-human chorionic gonadotropin levels, color Doppler velocimetry and hysteroscopy were used to monitor therapy. In view of the substantial morbidity associated with this form of ectopic pregnancy, medical management is an option for treatment.

Adult↗
PubMed1992

Transvaginal color duplex sonography: clinical potentials and limitations.

This overview describes our preliminary experience in the application of transvaginal color Doppler sonography in evaluation of the uterus and ovaries. The main indications for this type of sonography include evaluation for ovarian torsion, differentiation of benign from malignant ovarian masses, diagnosis of pelvic congestion, and assessment of utero-ovarian perfusion. Obstetric applications include evaluation of complicated early pregnancy and evaluation of placental disorders such as placenta accreta. No doubt future applications will arise soon from active investigation with this new technique.

Adnexal Diseases↗
PubMed1992

Conventional and color Doppler transvaginal sonography in gynecologic infertility. Current clinical applications.

TVS affords accurate follicular monitoring and guidance for follicular aspiration. The role of TVS in assessing the adequacy of the endometrium is still undergoing investigation. Our studies suggest that there is a statistically significant difference in the pregnancy rate when the endometrium has a multilayered appearance. Infertility patients who successfully achieve pregnancy should be monitored with TVS because of a higher incidence of ectopic pregnancy, anembryonic gestation, and spontaneous abortion. TVS has a secondary role in evaluating certain uterine malformations and tubal disorders. With TV-CDS it is also possible to evaluate physiologic parameters such as adnexal and uterine blood flow. The role of TV-CDS in the anatomic and physiologic evaluation of early pregnancy is now being established.

Color↗
PubMed1991

New applications of pelvic sonography.

This review discusses and illustrates the many applications of transvaginal sonography in gynecology. TVS has improved the accuracy of evaluation of pelvic masses and affords a means for accurate guided aspiration. The accuracy of follicular monitoring and aspiration is also enhanced with transvaginal sonography. The possible applications of transvaginal sonography as a means for screening for early ovarian carcinoma is also discussed as well as applications involving evaluation of the uterus and endometrium.

Female↗
PubMed1991

Duplex Doppler sonography of the umbilical arteries: predictive value in IUGR and correlation with birth weight.

Forty-three women with either clinically high-risk singleton pregnancies or a predicted fetal weight less than the 10th percentile were studied in their third trimester by duplex Doppler sonography of the free umbilical artery to assess the associations between umbilical arterial flow resistance and intrauterine growth retardation (IUGR) and birth weight. Test criteria included: the greatest (GRI), mean (MRI), and least (LRI) resistive index. The criterion with the strongest association with IUGR (p = 0.001) was the parameter of the LRI predicting IUGR). Linear regression analysis showed a nonsignificant correlation between RI and percentile birth weight, with r2 = 0.05 and p = 0.131. While significant associations can be shown between RI and IUGR, the clinical use of the results of this test should reflect the imprecise nature of these correlations.

Birth Weight↗