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Biomedical subjects

D Jurkovic

Publications and source records attributed to D Jurkovic.

At least 55 records · Page 3Linked to original sources
PubMed1998

Comparison of transvaginal color Doppler imaging and color Doppler energy for assessment of intraovarian blood flow.

OBJECTIVE: To investigate any systematic differences in the analysis of blood flow velocity waveforms derived by color Doppler imaging and color Doppler energy examination of corpora lutea and adnexal tumors, to test whether the accuracy for diagnosing ovarian malignancy differs between end points derived by color Doppler imaging and color Doppler energy, and to compare the reproducibility of flow velocity waveform analysis obtained by both methods. METHODS: Fifty-six asymptomatic women with presumed corpora lutea and 67 women with known adnexal masses were included in the study. They all were examined using transvaginal sonography with color Doppler imaging and color Doppler energy. Pulsed Doppler sonography was used to obtain flow velocity waveforms to determine the pulsatility index (PI), resistance index (RI), peak systolic velocity, and time-averaged maximum velocity. The tumors were classified retrospectively according to histologic criteria. RESULTS: There were 52 women with benign, three with borderline, and 12 with malignant ovarian tumors. Repeated-measures analysis of variance revealed no systematic differences in the values of all four measurements performed under color Doppler imaging and color Doppler energy for all cases of corpora lutea and adnexal tumors (PI: P=.153, RI: P=.197, peak systolic velocity: P=.355, time-averaged maximum velocity: P=.159). All cases of borderline and malignant tumors had detectable pulsatile blood flow with color Doppler imaging and color Doppler energy. Forty-two (80.8%) of the benign tumors had flow detectable with color Doppler imaging, compared with 40 (76.9%) with color Doppler energy (P=.480). Analysis of receiver operating characteristic curves showed a marginal but nonsignificant improvement in diagnostic performance with color Doppler energy compared with color Doppler imaging for all four measurements (PI: P=.182, RI: P=.178, peak systolic velocity: P=.254, time-averaged maximum velocity: P=.238). The intraclass correlation coefficients for all four measurements were superior with color Doppler imaging compared with color Doppler energy. CONCLUSION: Flow velocity waveform analysis and diagnostic accuracy for ovarian malignancy are not significantly different between color Doppler imaging and color Doppler energy. Examinations with color Doppler imaging appear to be more reproducible than those with color Doppler energy.

Adult↗
PubMed1998

Placental nitric oxide production and umbilical artery vascular impedance in early pregnancy.

OBJECTIVE: To evaluate whether the vasorelaxant molecule nitric oxide (NO) and its second messenger cyclic guanosine monophosphate (cGMP) modulate the reduction in resistance within the fetoplacental circulation that occurs during the first trimester of pregnancy. METHODS: We studied 27 women undergoing termination of pregnancy for psychosocial indications between 9 and 15 weeks' gestation. Each had ultrasound dating of the fetus and Doppler umbilical artery (UA) flow investigation immediately before the operation. Placental tissue was assayed for nitric oxide synthase (NOS) activity and cGMP content. RESULTS: Both UA pulsatility index (PI) and placental endothelial NOS activity decreased significantly with advancing gestation (r = -.52 and -.41, respectively). Umbilical PI correlated positively with endothelial NOS activity and cGMP level. Multiple linear regression analysis indicated that cGMP contributed most strongly to UA PI (P < .001). CONCLUSION: Our findings suggest somewhat paradoxically that NOS activity and cGMP levels are highest in the early gestations, when umbilical PI is also high, and decrease as umbilical PI decreases. Further studies are required to determine whether the predominant effect of NO is that of a vascular relaxant or a modulator of new villous vessel formation.

Blood Flow Velocity↗
PubMed1998

Unexpected effect of a nitric oxide donor on uterine artery Doppler velocimetry in oligomenorrheic women with polycystic ovaries.

We compared uterine artery vascular responses following administration of the nitric oxide donor glyceryl trinitrate to ten women with oligomenorrhea and ultrasound evidence of polycystic ovaries with those of nine women with a normal menstrual cycle and ultrasonically normal ovaries. Mean arterial blood pressure, pulse rate and uterine artery flow velocity waveforms were recorded before and 60-75 min after glyceryl trinitrate patch application. The pulsatility index and resistance index were calculated to describe changes in impedance to flow in the uterine artery. Peak systolic and time-averaged velocities were also measured. Pretreatment median arterial pressure was higher in women with polycystic ovaries (90 mmHg) compared to those with regular cycles (80 mmHg) (p < 0.05). No differences were found in pulse rate and uterine artery blood flow indices between the two groups. After glyceryl trinitrate patch administration, there was no change in blood pressure or pulse rate in either group. In women with polycystic ovaries, there was an increase in uterine artery resistance index (0.93 to 1.00; p < 0.05) and pulsatility index (3.77 to 4.99; p < 0.05) and a decrease in peak systolic (36.8 to 32.3 cm/s; p < 0.05) and time-averaged maximum (8.5 to 5.0 cm/s; p < 0.05) velocities. Uterine artery Doppler parameters remained unchanged in women with normal cycles. Uterine artery vascular responses to the nitric oxide donor glyceryl trinitrate are different in women with normal cycles compared to oligomenorrheic women with polycystic ovaries. This may be relevant to an understanding of the pathophysiology underlying the higher risk of cardiovascular morbidity and mortality associated with polycystic ovarian syndrome.

Adult↗
PubMed1998

Expectant management of missed miscarriage.

The option of expectant management was offered 221 women with ultrasound diagnosis of missed miscarriage. Eighty-five women (38%) accepted; the remaining 136 women chose surgical evacuation of retained products of conception. In the expectant management group 21 women (24.7%) had a complete miscarriage, 14 (16.5%) had incomplete miscarriage necessitating surgery, and 50 (58.8%) requested surgery within 48 days from the original diagnosis. These results suggest that the success of expectant management of missed miscarriage is too low to justify its use in routine clinical practice.

Abortion, Induced↗
PubMed1997

Coelocentesis: a study of short-term safety.

Coelocentesis was performed in 20 singleton pregnancies at 6-10 weeks of gestation and 2-13 days before planned termination. The control group consisted of 100 women who were also undergoing planned termination and were matched with the study group for maternal age and gestation. During the follow-up period, there were five miscarriages (25 per cent) after coelocentesis and five in the control group (5 per cent) (chi 2 = 6.68; P < 0.01). The high risk of miscarriage following coelocentesis makes the technique unsuitable for early prenatal diagnosis.

Adolescent↗
PubMed1997

Transfer of inulin across the first-trimester human placenta.

OBJECTIVE: Our aim was to investigate the transfer of inulin from the mother to the first-trimester fetus. STUDY DESIGN: A bolus of inulin (5 mg/kg) was administered to nine healthy volunteers with pregnancies between 6 and 12 weeks of gestation scheduled for elective termination of pregnancy. Coelomic and amniotic fluid samples were obtained from the corresponding cavities between 8 and 25 minutes after the end of the bolus of inulin. Fetal fluid inulin concentrations were compared with those of matched samples of maternal blood and urine collected simultaneously. RESULTS: Inulin was detected in all fetal and maternal samples. A trend toward an increasing inulin concentration was noted in the exocoelomic cavity with advancing time. Coelomic and maternal serum inulin concentrations were similar within 20 minutes after injection. Amniotic inulin concentrations were always lower than coelomic concentrations irrespective of gestational age or advancing time after injection. CONCLUSIONS: Inulin crosses the first-trimester human placenta from 7 weeks of gestation in quantities that yield measurable concentrations in both coelomic and amniotic fluids. These results suggest that the study of drug transfer in the first trimester of human pregnancy is feasible with use of samples obtained from the exocoelomic cavity.

Female↗
PubMed1997

Umbilical cord cysts in early pregnancy.

OBJECTIVE: To assess the prevalence, morphologic characteristics, and natural history of umbilical cord cysts detected by ultrasound in the first trimester of pregnancy. METHODS: This was an ultrasound screening study for the presence of umbilical cord cysts in 859 pregnant women with singleton live fetuses at 7-13 weeks' gestation. In all cases of cord cysts the scan was repeated fortnightly until the cyst resolved or a fetal abnormality was detected. All patients with ongoing pregnancies had detailed scans at 20 weeks. Infants and umbilical cords were examined after delivery for the presence of structural abnormalities. RESULTS: Umbilical cord cysts were present in 29 (3.4%) of the 859 pregnancies. Fetal abnormalities were found in seven (26%) of the 27 cases with ongoing pregnancies. The fetus was more likely to be abnormal if the cyst was located near the placental or fetal extremity of the cord (relative risk [RR] 3.3; 95% confidence interval [CI] 1.3, 8.5) or paraxially (RR 3.8; 95% CI 1.2, 12.0) or if it persisted beyond 12 weeks' gestation (RR 7.7; 95% CI 3.2, 18.6). CONCLUSIONS: The prevalence of umbilical cord cysts at 7-13 weeks' gestation is approximately 3%, and in more than 20% of cases there are fetal chromosomal or structural defects.

Adult↗
PubMed1997

Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis.

The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. Sixty-seven women with known adnexal masses were examined using transvaginal B-mode and color Doppler imaging. For each patient the variables included: (1) age, (2) maximum tumor diameter, (3) tumor volume, (4) unilocularity (presence (0) or absence(1)), (5) papillary projections (presence (1) or absence (0)), (6) random echogenicity (presence (1) or absence (0)), (7) highest peak systolic velocity (PSV), (8) time-averaged maximum velocity (TAMXV), (9) pulsatility index (PI) and (10) resistance index (RI). The TAMXV, PI and RI were those associated with the highest PSV. These ten independent variables and the final histological diagnosis for each patient (the dependent variable) were used for the regression analysis. Approximately 75% of the entire dataset was randomly selected for generating the regression model. The remaining 25% was used as the testing set for cross-validation of the model. In the entire dataset there were 52 women with benign, three with borderline and 12 with invasive ovarian tumors. Regression analysis on the ten variables resulted in the retention of only 'age', 'papillary projection score' and 'TAMXV' as significantly contributing to predicting the presence or absence of malignancy. The probability of malignancy for any patient was given by solving the equation: Probability = 1/(1 + e-z) where e is the base value for natural logarithms and z = (0.1273 x Age) + (0.2794 x TAMXV) + (4.4136 x Papillary projections score) - 14.2046. Cross-validation of the model on the test set of data gave a 100% sensitivity and specificity. However, for the entire dataset the best sensitivity and specificity were 93.3 and 90.4%, respectively, at a cut-off value of 25% probability of malignancy. In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently. The value of this model needs to be tested prospectively.

Adult↗
PubMed1997

Body stalk anomaly at 10-14 weeks of gestation.

In a multicenter project of screening for chromosomal defects by fetal nuchal translucency thickness and maternal age at 10-14 weeks, 14 of 106,727 fetuses examined had body stalk anomaly. The ultrasonographic features were a major abdominal wall defect, severe kyphoscoliosis and a short umbilical cord. In all cases, the upper part of the fetal body was in the amniotic cavity, whereas the lower part was in the celomic cavity. The nuchal translucency thickness was above the 95th centile in ten (71.4%) of the cases, but the fetal karyotype was normal in all 12 fetuses evaluated. The findings suggest that early amnion rupture before obliteration of the celomic cavity is a possible cause of the syndrome.

Abdominal Muscles↗
PubMed1997

Massive ascites due to abdominal pregnancy.

We describe a case of an abdominal pregnancy which presented in the first trimester with rapid accumulation of blood stained ascites. The ascites resolved completely following surgical removal of a gestational sac from the peritoneal cavity. The pathophysiology of ascites in this case may be similar to that in cases of ascites in other non-malignant gynaecological conditions.

Adult↗
PubMed1997

Ultrasound screening for congenital uterine anomalies.

The aim of this study was to investigate the prevalence of congenital uterine anomalies in 1046 women attending gynaecological ultrasound clinics for a variety of indications. Using three-dimensional ultrasound, anomalies were found in 55 women (5.4%), including 32 (3.1%) with an arcuate uterus and 23 (2.3%) with major anomalies. The prevalence of uterine anomalies was similar to the findings in women undergoing elective sterilisation, but lower than in studies of women with recurrent miscarriage.

Adult↗
PubMed1996

A comparison of intratumoural indices of blood flow velocity and impedance for the diagnosis of ovarian cancer.

The aim was to assess the value of blood flow velocity indices in an ultrasound-based test to discriminate between malignant and benign adnexal tumours. Fifty-one women (35 premenopausal and 16 postmenopausal) with persistent adnexal masses were scanned prior to surgery using transvaginal sonography with colour Doppler imaging. Intratumoural flow velocity waveforms obtained by pulsed Doppler sonography were used to determine the time averaged maximum velocity (TAMXV), peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI). The tumours were classified by histologic criteria (42 benign, 1 borderline and 8 malignant tumours). Two of the malignant and the single borderline tumour were stage I, five were stage III and one was stage IV. Detectable blood flow signals were found in all malignant and borderline tumours and in 33 of 42 (78.6%) of the benign tumours. TAMXV was the best parameter for discrimination of benign and malignant adnexal pathology and at a cut-off value of TAMXV > or = 12 cm/s to indicate malignancy, the sensitivity and specificity were 88.9% and 81.0%, respectively. At the same sensitivity level, this gave a better specificity than the PI < or = 0.90 (specificity 61.9%, P = 0.036), RI < or = 0.60 (specificity 54.8%, P = 0.010) and PSV > or = 16 cm/s (specificity 71.4%, P = 0.121). Discrimination between benign and malignant tumours was improved further by using two criteria rather than one. When the two criteria of a TAMXV of > or = 12 cm/s and a PI < or = 1.0 were applied simultaneously, the tumours could be characterised with a sensitivity of 88.9% and a specificity of 88.1%. Therefore, intratumoural PSV and TAMXV could be used to discriminate between benign and malignant adnexal tumours better than values for PI and RI. The best discrimination was achieved by using a combination of cut-off values for velocity and impedance parameters as two criteria to define malignancy.

Adult↗
PubMed1996

The diagnostic value of endometrial thickness and volume measurements by three-dimensional ultrasound in patients with postmenopausal bleeding.

We compared endometrial thickness and volume in patients with postmenopausal bleeding, and examined the value of each parameter in differentiating between benign and malignant endometrial pathology. A total of 103 patients with a history of postmenopausal bleeding were recruited into the study. Patients who were taking hormone replacements therapy or other hormonal preparations with a known effect on the endometrium were excluded. Each patient underwent three-dimensional ultrasonography for the measurement of endometrial thickness and volume. In 97 cases both of these measurements were obtained and the results were compared to the histological diagnosis after endometrial biopsy or dilatation and curettage. Endometrial cancer was diagnosed in 11 patients. The mean endometrial thickness was 29.5 mm (SD 12.59) and the mean volume was 39.0 ml (SD 34.16). In the remaining 86 patients there were eight cases with endometrial hyperplasia and seven with endometrial polyps. The endometrial thickness and volume in patients with benign pathology was 15.64 mm (SD 5.26) and 5.47 ml (SD 6.32), respectively. In 71 patients with atrophic or normal endometrium the mean thickness and volume was 5.29 mm (SD 3.97) and 0.91 ml (SD 1.71), respectively. Receiver operating characteristic curves showed endometrial volume to be superior to endometrial thickness for the diagnosis of endometrial cancer. The optimal cut-off value of endometrial thickness for the diagnosis of cancer was 15 mm, with the test sensitivity of 83.3% and positive predictive value of 54.5%. With the cut-off level of 13 ml for endometrial volume measurement the sensitivity was 100% and the positive predictive value 91.7%. Both the thickness and volume were higher in patients with advanced and less differentiated cancers. The measurements of endometrial volume was superior to that of endometrial thickness as a diagnostic test for the detection of endometrial cancer in symptomatic postmenopausal women.

Aged↗
PubMed1996

Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively.

We report two cases of cervical pregnancy which were diagnosed by ultrasound at 5 and 8 weeks' gestation. In both cases a gestational sac was visualized below the internal os and color Doppler examination demonstrated peritrophoblastic blood flow characteristic of early implantation. Both patients were successfully treated with systemic methotrexate. Including these two cases, a total of 83 early cervical pregnancies have been reported in the literature over the last 10 years. Of these, 40 patients were primarily treated by conservative surgery, 40 by non-surgical methods using methotrexate or potassium chloride, and the remaining three by other chemotherapeutic agents. The likelihood of being cured was similar in the surgical and non-surgical groups (odds ratio 1.1; 95% confidence interval 0.4-3.2). However, patients who were primarily treated by surgery were more likely to sustain major hemorrhage (odds ratio 8.0; 95% confidence interval 2.4-26.5) and to require hysterectomy (odds ratio 7.4; 95% confidence interval 0.9-63.8) than those treated medically. This indicates that non-surgical methods should be used for primary treatment of cervical pregnancy, while surgery should be reserved for those patients in whom medical therapy is not successful.

Adult↗
PubMed1996

In-vivo study of diazepam transfer across the first trimester human placenta.

Diazepam transfer by the first trimester human placenta was investigated at pregnancy termination between 6 and 12 weeks of gestation. Fetal fluid samples were obtained from the exocoelomic and amniotic cavities of 65 pregnancies between 8 and 25 min following the i.v. administration of 0.1 mg/kg diazepam to the mother. Diazepam was detected in one-third of coelomic fluid samples and two-thirds of amniotic fluid samples. Maternal serum and urine diazepam concentrations correlated negatively and positively respectively, with time from drug injection to sampling. Individual diazepam concentrations were low on the fetal side, and the corresponding concentrations were independent of maternal serum concentrations and the time from drug injection to sampling. Amniotic fluid diazepam content increased significantly with advancing gestational age. A multiple regression analysis showed that the diazepam content of the coelomic fluid was not influenced by maternal serum diazepam concentration, the time from drug injection to sampling or gestational age, whereas only gestational age contributed to the diazepam content of amniotic fluid. These data demonstrate that the placental transfer of diazepam occurs from week 6 of gestation, indicate a preferential transfer of this drug to the amniotic cavity and suggest that diazepam may accumulate in fetal circulation and tissues during organogenesis.

Adult↗
PubMed1996

Biochemical investigation of fetal renal maturation in early pregnancy.

The objective of this study was to evaluate the biochemical indices of normal fetal kidney maturation in early pregnancy. Urea, creatinine, gamma-glutamyltransferase, and beta 2-microglobulin levels were measured on paired samples of amniotic and coelomic fluids and maternal serum collected at the time of pregnancy termination in a group of woman with pregnancies between 8 and 11 wk, or on paired samples of amniotic fluid and maternal serum collected from woman undergoing early transabdominal amniocentesis between 11 and 16 wk. Before 11 wk of gestation (n = 12), significantly lower concentrations of creatinine and beta 2-microglobulin, and higher concentration of gamma-glutamyltransferase were found in amniotic fluid compared with both maternal serum and coelomic fluid. Significant positive correlations were found between gestational age (8-16 wk) and amniotic fluid (n = 47) levels of urea (r = 0.45; p < 0.01), creatinine (r = 0.68; p < 0.001), gamma-glutamyltransferase (r = 0.71; p < 0.001), and beta 2-microglobulin (r = 0.69; p < 0.001). The maternal serum levels of the corresponding variables did not varied significantly. The abrupt increase in creatinine, gamma-glutamyltransferase, and beta 2-microglobulin amniotic fluid concentrations after 10 wk of gestation provides biochemical evidence for the maturation of the fetal renal glomerular function at a time when the reabsorption capacity of the proximal tubular cells is not established. We suggest that this important variation in the amniotic fluid composition, unrelated to any comparable changes in the maternal serum, reflects the fetal kidney development from the mesonephros to the metanephros.

Amniotic Fluid↗
PubMed1996

Selection and identification of standard cardiac views from three-dimensional volume scans of the fetal thorax.

The feasibility of fetal echocardiographic examination using three-dimensional ultrasonography was investigated in 54 healthy pregnant women with uncomplicated pregnancies between 17 and 37 weeks of gestation. In 46 cases (85.2%), good quality three-dimensional volumes of the fetal heart were obtained from both apical and lateral four-chamber views. By reslicing apical volumes, the reformatted sections of the long axis view of the left ventricle and the aortic crest were seen in 40 (87%) and 38 (83%) of 46 cases, respectively. The short axis was seen in 26 (57%) and ductal arch in 30 (65%) cases. The examination of lateral volumes was much less successful. The short axis was seen in 11 (24%) cases, and the aortic crest in 22 (48%), whereas the analysis of the longitudinal views was not possible. The best results were obtained at a gestational age between 22 and 27 weeks. Three-dimensional fetal echocardiography allowed the examination of the four chambers of the heart and left outflow tract during the late second trimester. The technique may become useful for the screening and diagnosis of congenital cardiac defects in the future.

Aorta↗