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Biomedical subjects

E Merz

Publications and source records attributed to E Merz.

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

A new sonomorphologic scoring system (Mainz Score) for the assessment of ovarian tumors using transvaginal ultrasonography. Part I: A comparison between the scoring-system and the assessment by an experienced sonographer.

OBJECTIVE: The problem of an accurate sonographic assessment of ovarian tumor status has not yet been solved. To what extent can the preoperative assessment of adnexal tumors be improved on the basis of a maximum number of sonographic tumor parameters included in the newly developed sonomorphologic Mainz Score? MATERIALS AND METHODS: In a prospective study 314 premenopausal patients with adnexal tumor underwent a transvaginal sonographic examination performed by an experienced sonographer. In parallel to the sonographic examination a new score including 10 different sonographic parameters was used to predict adnexal tumor status: 1. Total tumor structure, 2. tumor border, 3. wall thickness, 4. inner echos in cystic component, 5. septa, 6. shape of echo complex or of the completely solid tumor, 7. echogenicity of the echo complex or of the completely solid tumor, 8. acuostic phenomena behind tumor, 9. ascites, 10. detection of liver metastases/peritoneal carcinosis Depending on the respective degree of expression, the individual characteristics were rated on a scale from 0 to 2. The total score obtained following addition of the points recorded for each parameters served to confirm the validity of the sonographic tumor status assessment. The first sonographer assessed the tumor status based on his experience and in the knowledge of all clinical parameters. The second sonographer evaluated the tumor status based on the score. All preoperative ultrasonographic findings were compared with the postoperative histologic analysis. RESULTS: A maximum number of 20 points may be obtained using the Mainz Score. Tumors with a total score of below 9 were rated as benign and those with a score of above 9 as malignant. This resulted in a sensitivity of 96.4%, a specificity of 80.7%, a positive predictive value of 47.4%, and a negative predictive value of 99.6%. The predictive value of the scoring-system was diminished by the presence of 30 false-positive cases, which were identified as inflammatory conglomerate tumors, teratomas, endometrial cysts, cystadenomas and hemorrhagic cysts. The experienced sonographer assessed 233 cases as benign and 24 cases as malignant. The findings were confirmed by the histological examination in 252 of 257 cases. No conclusive prediction of tumor status could be made in 57 tumors. However, the application of the Mainz Score enabled an accurate prediction of the tumor status in 44 of the 57 cases. With the exception of septal thickness all assessment criteria of the score showed a statistically significant correlation between the assigned score and the histologic findings, (p < 0.05). CONCLUSIONS: The use of the Mainz Score enables even less experienced sonographers to assess the status of premenopausal adnexal tumors with a high degree of accuracy. The score provides the experienced sonographer with a refined and improved method for the prediction of tumor status, especially in the presence of not readily assessable findings.

Adolescent↗
PubMed1998

Prenatal diagnosis of major malformations: quality control of routine ultrasound examinations based on a five-year study of 20,248 newborn fetuses and infants.

Antenatal ultrasound screening for birth defects is increasingly becoming a routine procedure of prenatal care. Prenatal detection of malformations and subsequent adjustment of obstetric management are essential for secondary prevention. It is unknown whether ultrasound screening is effective in all pregnant women, or should only be performed in high risk populations. From 1990-1994, 20,248 livebirths, stillbirths and abortions underwent physical and sonographic examinations and anamnestic data were collected. To identify the high risk group, case control analyses of births with one of the 23 selected major malformations (controls) were performed with respect to anamnestic risk factors. All women had at least three routine ultrasound scans. The selected malformations were diagnosed in 298 children; 95 (30.3 per cent) were diagnosed antenatally. Detection rates were: CNS (68.6 per cent), gastro-intestinal tract (42.3 per cent), urinary system (24.1) per cent), heart (5.9 per cent). Complications during pregnancy were calculated as indicators of congenital anomalies: premature labour (< 28 week) OR 4.7 (3.8-5.9), placental insufficiency OR 1.9 (1.1-2.7) and vaginal bleeding OR 1.5 (1.2-1.8), etc. Antenatal routine ultrasound screening is not effective risk populations. Anamnestic risk factors risk factors during pregnancy may be essential indicators for identifying high risk populations. We propose screening of the described high risk pregnancies (about 22 per cent of all pregnancies) to be performed by specially trained and highly experienced ultrasonographers to increase sensitivity rates and benefit cost effectiveness.

Central Nervous System↗
PubMed1997

Application of transvaginal and abdominal three-dimensional ultrasound for the detection or exclusion of malformations of the fetal face.

In a total of 618 pregnant women between 9 and 37 weeks' gestation, the fetal face was evaluated by two-dimensional and three-dimensional ultrasound imaging as part of a level III screening evaluation for fetal anomalies. A three-dimensional endovaginal probe (5 MHz) was used for examinations at between 9 and 15 weeks, and an abdominal three-dimensional probe (3.5 MHz) was used after 15 weeks. Three different three-dimensional image display modes were employed: (1) the orthogonal display; (2) the surface display; and (3) the transparent display. When we studied the three-dimensional orthogonal displays in a 125 cases evaluated by abdominal ultrasound, we found that the facial profile shown in the two dimensional image represented the true mid-sagittal profile in only 69.6% of the cases. In the remaining 30.4%, the profile view deviated from a true mid-sagittal section by up to 20 degrees in one or two planes. In a total of 25 facial anomalies detected by abdominal ultrasound, 20 were clearly demonstrated by both two-dimensional and three-dimensional technology. In the remaining five cases, three-dimensional ultrasound revealed or confirmed an additional defect or abnormality: a narrow cleft lip in an unfavorable position of the fetal face (n = 2), a unilateral orbital hypoplasia (n = 1), a cranial ossification defect (n = 1) and a flat profile in the presence of marked oligohydramnios (n = 1). When transvaginal scanning was used, there were cases in which a detailed surface image of the fetal face could be obtained as early as 9 weeks' gestation. Abdominal scanning routinely yielded high-quality surface images by 20 weeks. Three-dimensional ultrasound consistently displayed facial abnormalities with greater accuracy and clarity than conventional two-dimensional imaging. This particularly applied to chromosomal aberrations and syndromes associated with subtle facial abnormalities requiring a detailed evaluation. Not only does three-dimensional ultrasound help in appreciating the severity of a fetal defect, but it can also provide more convincing evidence of a normal fetus than conventional two-dimensional sonograms.

Face↗
PubMed1997

[Current technical possibilities of 3D ultrasound in gynecology and obstetrics].

3D sonography offers the possibility of storing complete 3-dimensional volumes, not only individual image planes as was the case with 2D sonography. Once the scan is completed, all the sectional planes within the volume can be accessed from the memory, processed, and displayed in the same way that three-dimensional surface-rendere or transparent views are computed and displayed. Update 3D technologies enable 3D real time observation of stored volumes, so that abnormal findings in both obstetrics and gynaecology can be directly observed three-dimensionally without having to wait for several minutes until the images have been computed.

Congenital Abnormalities↗
PubMed1997

[Transvaginal ultrasound biometry in early pregnancy--a growth model].

PURPOSE: Evaluation of a growth model for the biometric parameters of early pregnancy: Chorionic cavity, yolk sac, amniotic cavity, crown-rump length and biparietal diameter. METHOD: 618 clinically well-dated singleton pregnancies of the first trimester were measured in a prospective cross-sectional study with high-frequency transvaginal ultrasound between 28 and 94 days post menstruation. RESULTS: Normal curves (5th, 50th, 95th percentiles) for all parameters were established using our growth model. The growth curves of chorionic cavity amniotic cavity, and biparietal diameter showed a linear growth whereas the growth curve of the crown-rump-length represented an exponential curve. Linear growth of the yolk sac was found until 8 weeks of gestation and there was no growth alteration after this time. CONCLUSION: With our growth curves of the first trimester it is possible to monitor the embryonic development with several parameters.

Anthropometry↗
PubMed1997

[Ultrasound assessment of ovarian tumors--comparison between transvaginal 3D technique and conventional 2-dimensional vaginal ultrasonography].

DEFINITION: Three-dimensional (3D) ultrasound is capable of visualising all three orthogonal planes simultaneously. With the stored volumetric data, imaging planes can be reconstructed that are not visible when using standard vaginosonographic procedures. AIMS OF THE STUDY: In patients with ovarian tumours, diagnosis and the appropriate therapeutic approach depend to a crucial degree upon the results of sonographic investigations, which therefore need very exact diagnostic data. Two-dimensional (2D) vaginosonography can only yield sagittal and frontal sections of the lesser pelvis; 3D volume scanning, however, visualises all three perpendicular planes simultaneously on a monitor screen. In cystic tumours of the ovary, conspicuous parietal structures can be specifically localised and rendered three-dimensionally in the surface mode. Such imaging capabilities create new perspectives in assessing ovarian tumours. METHOD: Within the framework of a prospective study at the Gynecological Clinic of the University of Mainz, we compared the sonographic findings obtained for 45 patients with ovarian tumours using 2D and 3D vaginosonography. After the transvaginal application of conventional 2D vaginosonography, the tumours were examined by means of 3D sonography. RESULTS: The use of 3D volume scanning was advantageous because we could image specifically targeted planes and reconstruct image planes that cannot be shown using standard vaginosonography. In addition, the volumetric technique allows 3D surface reconstruction of conspicuous parietal structures from a wide variety of different perspectives. These advantages allow one to better assess the grading of tumours especially of those that are cystic. Problems associated with the application of this transvaginal 3D technique module orientation within a given volume, the overlapping of sonographic planes, increase the time required for surface calculations and increased data storage capacity. CONCLUSION: Transvaginal 3D sonography represents a new technique of imaging. Owing to its ability to register all three imaging planes simultaneously as well as to visualise surfaces three-dimensionally, this technique opens up new sonomorphologic possibilities in the evaluation of ovarian tumours.

Adolescent↗
PubMed1997

[The internet--new communication structures for ultrasound diagnosis in gynecology?].

Within the last two years a great number of internet pages have become a highly interesting source of up-to-date information in ultrasound diagnosis in obstetrics and gynecology. Most of these World Wide Web-pages present high quality ultrasound images (3D, colored doppler scans), while scientific information or special clinical discussion groups are still rare. The potential of new graphical internet techniques will strongly influence communication and education in cases of ultrasound in obstetrics and gynecology.

Computer Communication Networks↗
PubMed1996

Sonographic size of uterus and ovaries in pre- and postmenopausal women.

Uterine and ovarian size were measured in 765 pre- and postmenopausal women by transvaginal ultrasound. Of these, 263 (premenopausal, n = 155; postmenopausal, n = 108) were found to have neither uterine nor ovarian pathological findings. According to parity, premenopausal women were separated into three groups: nullipara, primipara and multipara. Postmenopausal women were separated into two groups according to years since menopause: < or = 5 years and > 5 years since menopause. In the premenopausal group, a parity-related enlargement in uterine size was observed between nulliparous and parous women. After the menopause, a significant reduction in uterine size and in the corpus-cervix ratio was observed. The reduction in uterine size was related to years since menopause. The endometrial thickness measured in the group of premenopausal women did not exceed 4 mm on day 4 and 8 mm on day 8 of the menstrual cycle; in the postmenopausal group, endometrial thickness did not exceed 5 mm (mean 3.6 mm). In the group of premenopausal women, no parity-related change in ovarian volume was observed. After menopause, there was an obvious reduction in ovarian volume. Between the two postmenopausal groups, there was a small but significant difference in ovarian volume.

Adolescent↗
PubMed1996

[Normal fetal growth profile--a uniform model for calculating normal curves for current head and abdomen parameters and long limb bones].

AIM: Age-related and uniformly defined standard graphs were obtained for the fetal parameters BPD, OFD, HC, ATD, ASD, AC, Fe, Ti, Fi, Hu, Ra and Ul. METHODS: Data of 2032 healthy pregnant women of sonographically confirmed gestational age were used in a prospective cross-sectional study to establish reference charts for the fetal head and abdomen and the long limb bones. Only patients with an uncomplicated pregnancy were included in the study. The gestational age at which the measurements were taken ranged from 12 to 41 completed weeks. All measurements were performed as external-to-external measurements. RESULTS: By means of a mathematical model age related standard reference ranges were calculated on the basis of a single formula. Uniformly well-defined standard graphs were obtained for all parameters. All fetal parameters showed a nonlinear fetal growth. SUMMARY: Contrary to the common methods of creating reference standards by means of high-degree polynomials, the mathematical model presented here has the advantage of characterising the course of several parameters on the basis of one single formula. This is of great importance for digitising fetal charts in commercially available ultrasound machines.

Anthropometry↗
PubMed1996

Unruptured tubal pregnancy: local low-dose therapy with methotrexate under transvaginal ultrasonographic guidance.

Thirty patients with unruptured ectopic pregnancy (4-10 weeks' gestation) were treated locally with methotrexate (MTX) under sonographic guidance. The transvaginal puncture was performed under analgesic sedation using an automatic puncturing device. Local MTX therapy was successful in 25 patients (83.3%). Eighteen of these patients had received a single MTX instillation with a total dose of 10 mg, 7 patients had received a second instillation with 10 mg because of plateauing hCG levels after the first instillation. In 5 patients MTX therapy was unsuccessful. Surgical intervention was necessary within 4 h to 15 days after MTX treatment, due to severe tubal bleeding (n = 1) or the development of an increasing peritubal hematoma (n = 4). Patients with an outer trophoblast diameter < or = 1.5 cm could be treated successfully in all cases (25/25). In patients with hCG values > 5,000 mIU/ml the success rate was 70% (7/10) and in patients with demonstration of cardiac activity of the embryo 63% (5/8). The fluid aspirated from the ectopic cavity showed an average hCG concentration that was 53 times higher than in the serum. The decline in hCG to values below 10 mIU/ml ranged between 7 and 75 days (mean 28 days). The hysterosalpingography performed 4-6 months after MTX therapy showed tubal patency on both sides in 85.7% of the patients examined. In the meantime 4 of these patients gave birth to healthy children.

Adult↗
PubMed1995

Volume scanning in the evaluation of fetal malformations: a new dimension in prenatal diagnosis.

Three-dimensional ultrasound examination was performed in 204 patients with a fetal malformation detected by conventional ultrasound. The patients were examined between 13 and 40 weeks of gestation. The ultrasound equipment used was a Combison 330 and a Combison 530 (Kretztechnik, Austria) with an abdominal Voluson sector transducer (3.5/5 MHz) (Kretztechnik, Austria). This ultrasound system can provide a high-quality three-dimensional surface or translucency image of fetal structures similar to that of a photograph or an X-ray image within seconds without an additional expensive work-station. Of the 204 patients examined with three-dimensional ultrasound, this technique proved advantageous in demonstrating fetal defects in 62% (127/204). In 36% (73/204), the three-dimensional technique gave the same information and in four fetuses with a cardiac malformation (2%), the three-dimensional technique was disadvantageous, due to movement artefacts during data acquisition. The technical advantages and problems of this three-dimensional technique are demonstrated.

Artifacts↗
PubMed1995

Assessment of myometrial infiltration and preoperative staging by transvaginal ultrasound in patients with endometrial carcinoma.

In recent years, the incidence of carcinoma of the endometrium has shown an upward trend, such that it is currently the most frequently encountered malignant tumor of the female genital tract. An accurate preoperative diagnosis of the extent and spread of such carcinomas is of crucial importance for the selection of a therapeutic approach appropriate to the stage and infiltration of each particular tumor. In a prospective study of 80 patients with a carcinoma of the endometrium, performed at the Department of Obstetrics and Gynecology of the University of Mainz, we compared the preoperative findings of transvaginal sonography with the postoperative histological results with respect to the following parameters: endometrial thickness, demarcation of the boundary of the endometrium, myometrial infiltration depth and staging. In all of these patients, sonography revealed a distinct increase in the thickness of the endometrium. In all cases, the structure of the endometrium was found to be heterogenous, with an irregular and poorly delineated boundary. Assessments of the depth of tumor infiltration and the tumor staging obtained by transvaginal sonography were found to correlate with the histological findings in 85% and 87.5% of the cases, respectively. Thus, in cases of endometrial carcinoma, transvaginal sonography has an essential role to play in devising an individualized operative treatment program that takes into account the extent, spread and stage of the tumor.

Adult↗
PubMed1995

[Orbital diameter, inner and outer orbital distance. A growth model of fetal orbital measurements].

AIM: Aim of this study was to establish a growth model for the intrauterine growth of the following fetal parameters: orbital diameter, interorbital and biocular diameters. METHOD: Data were measured in a prospective cross-sectional study with real-time ultrasound. The study group consisted of 1090 healthy fetuses between 12 and 41 weeks gestation. For curve standardisation a growth model for all parameters was used. RESULTS: Using this growth model growth profiles (5., 50., and 95. percentiles) were established. All orbital parameters showed a nonlinear growth. CONCLUSION: Since ocular and orbital malformations (anophthalmia, microphthalmia, hypo- and hypertelorism) are often principal signs of generalised syndromes, orbital biometry is helpful for a detailed prenatal investigation of the fetal face. This is demonstrated in 2 cases with an orbital malformation (orbital hypoplasia, hypotelorism).

Cephalometry↗