[Sonographic detection of metastases of the spleen and splenic hilus in patients with ovarian cancer and breast cancer].
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Breast Neoplasms↗
Biomedical subjects
H Schillinger
Publications and source records attributed to H Schillinger.
[Assessing the extent of gynecologic tumors by a sonographic tumor score with special reference to ovarian cancer].
Ultrasonic findings in 1317 operatively confirmed gynecological tumors were classified according to five degrees of homogeneity: I, clearly outlined solitary cysts; II, clearly outlined homogeneous tumors; III, poorly defined or slightly heterogeneous tumors; IV, marked heterogeneous tumors; V, completely heterogeneous tumors. In the different groups, the rates of malignancy were: I, 0.9%, II, 1.9%; III, 17%; IV, 58%; and V, 75%. In a further study 1082 patients with a negative or doubtful result of the physical examination were investigated using ultrasound. Abnormal findings in 126 cases were able to detect 8 carcinomas, 25 kystomas, and 63 other tumors.
Female↗
[The prognosis of sonographically early diagnosed twin pregnancies].
We retrospectively analyzed 95 intact twin pregnancies (GG) only diagnosed by sonography during the period 1977-1987: 48 GG were registered up to the 10th week of pregnancy (G 10), 90 between the 11th and the 16th week of pregnancy inclusive (G 16). In the group G 10, this spontaneous fetal loss, including the perinatal mortality amounted to 10.9% (10 of 92) twins (GF). In 5 cases from this group, a previously vital twin was lost before the 10th week. The loss in group G 16, including the perinatal mortality, was 9.7% (17 of 176 twins GF). An early or late abortion occurred in 6 cases (6.8%) and dies perinatally in this group. 82 GG were carried out to full term. 38 women (46.3%) had premature births, 12 pregnancies (12.6%) ended before the 34th week of pregnancy. The perinatal mortality rate amounted to 3.0% (5 GF), 4 (2.3%) of 172 GF had serious malformations. In 6 GG (7.4%) the weight of the twins differed more than 25%.
Female↗
Prenatal diagnosis of Wiedemann-Beckwith syndrome.
We report the prenatal diagnosis of Wiedemann-Beckwith syndrome in the 28th week of pregnancy in a primigravida. The cause of hospitalization was severe polyhydramnios with premature labour. Sonography revealed macrosomia, nephromegaly, cysts of adrenal glands and a striking macroglossia with opened mouth in all controls. The combination of all these symptoms suggested the prenatal diagnosis of Wiedemann-Beckwith syndrome, which could be confirmed post partum after a normal delivery in the 33rd week of pregnancy. The newborn (2700 g, 48 cm) exhibited typical features of this syndrome as moderate hypoglycemia and polycythemia in addition to the sonographic finding. Pathogenetic aspects and differential diagnosis of macrosomia are discussed.
Adult↗
Management of multiple conceptions after gonadotropin-releasing hormone analog/human menopausal gonadotropin/human chorionic gonadotropin therapy.
The treatment course of a 31-year-old infertility patient due to PCO disease is presented. Because the patient failed to conceive after various treatment cycles with CC, she was subjected to a combined GnRHa/hMG/hCG therapy. After plasma E2 levels had reached 2400 pg/ml, three leading follicles, with diameters of 20 to 24 mm, were detected. Induction of ovulation was achieved by 10,000 IU hCG. The patient conceived and developed ovarian hyperstimulation. At 8 weeks of gestation, seven cystic structures were detected within the uterine cavity, five containing single embryos, and two with twin embryos. All nine embryos were vital, as evidenced by their heart beats. Embryo reduction was achieved by transabdominal puncture on three occasions. The three surviving fetuses were carried to the 34th week of gestation. After delivery by cesarean section, three healthy babies developed normally. This communication illustrates the complications that can be associated with ovulation induction in PCO disease: ovarian hyperstimulation, polyovulation, multiple conceptions, and their clinical management.
Adult↗
[Prenatal sonographic diagnosis of abdominal wall defects and stenoses of the intestinal tract].
Today prenatal sonographic diagnosis of abdominal defects and stenoses of the intestine is possible without few exceptions during general screening in the 20th week of gestation. In a retrospective study, 56 malformations in this area were investigated, which had been diagnosed at the University Hospital Freiburg during 1973 and 1985. Besides the criteria of sonographic diagnosis the etiology, incidence, prognostic factors, the course of pregnancy and delivery and the postpartal management are described. The rate of direct sonographic diagnosis in this area has increased from 26% up to 91%. The worst prognosis was found in infants with diaphragmatic hernias and exomphalos, whereas infants with stenosis of duodenum and small intestine had the best prognosis.
Abdominal Muscles↗
[Detection of liver metastases in gynecologic neoplasms by sonography, scintigraphy, computerized tomography and liver enzymes].
In a retrospective study the diagnostic validity of sonography (US), computer-tomography (CT), scintigraphy (SC) and serum alkaline phosphatase (AP) in the detection of liver metastases was evaluated in 929 patients with malignant tumors: ovary (n = 367), mamma (n = 189), endometrium (n = 181), cervix (n = 162), fallopian tube (n = 10), vulva (n = 20). Definitive diagnosis was confirmed by autopsy (n = 51), surgical intervention (n = 297) or follow-up (n = 581). Specificity, sensitivity and overall accuracy of the different methods in the indication of liver metastasis were as follows: CT (n = 58) 81%, 98%, 93%, US (n = 929) 70%, 94%, 90%, SC (n = 512) 66%, 85%, 81%, AP (n = 325) 68%, 93%, 87%. In the last examination period, US and CT reached comparable results. In view of efficiency, AP and US would appear suitable for routine control in gynecological malignancies.
Alanine Transaminase↗
[Differentiation of breast cancers by Doppler ultrasound].
Breast sonography is a well-accepted diagnostic method. For differentiation between benign and malignant lesions quantified sonography is gaining increased importance. In addition to measurements of velocity, attenuation and elastic properties of tissue, analysis of blood flow by CW Doppler ultrasound plays an important role. Malignancies usually show increased vascularity and extremely disorder. The peripheral resistance is low due to numerous AV-shunts in malignant tissue. With high frequency CW Doppler ultrasound (8-10 MHz) these anatomical and physiological features can be outlined objectively. Frequency analysis of Doppler signals in breast malignancies shows high intensities corresponding to increased blood flow. But also a broadening of the systolic peak with flattening of systolic increase and diastolic decrease as well as high diastolic flow. The different blood flow directions of the vessels recorded by the ultrasonic Doppler beam also cause broadening of the frequency range. In combination with B-mode ultrasound this method provides information essential for the differentiation of malignancies.
Breast Diseases↗
[Breast sonography with the new water bath scanning technics].
At 1188 patients we investigated the value of sonography of the breast in the detection of malignancies. We used 2 automatic multitransducer water-bath scanners, at first the 3 MH Octoson, then System 1, a dedicated 4 MH water-bath breast scanner which allows for compound and simple scans in any scanning plane. The sensitivity for detection of 63 malignancies was 87%. Other pathologies were 18 fibroadenomas, 160 cysts, 6 abscesses, 2 fatty necroses, 2 papillomas, 9 prostheses, one of them broken. The difficulties associated with differential diagnosis in breast sonography are discussed in detail.
Abscess↗
Simultaneous investigations of maternal cardiac output and fetal blood flow during hypervolemic hemodilution in preeclampsia--preliminary observations.
In pre-eclampsia hemodynamic alterations are characterized by a lack of plasma volume expansion and a raised peripheral vascular resistance. For the compensation of plasma volume deficit and to restitute blood fluidity the therapeutic use of plasma volume expanders (f.e. low molecular dextran) is recommended. Several groups (Goodlin et al., Cloeren et al., Heilmann et al., Seghal et al., Schröck) have demonstrated benefitial effects on fetal status and development in the course of hypervolemic hemodilution in preeclampsia. This therapeutic procedure presumes the continuous surveillance of maternal hemodynamics to early recognize heart insufficiency or fluid overload in the lungs. We use the noninvasive thoracic impedance cardiography for continuous monitoring of maternal heart performance. The effect of hypervolemic hemodilution on fetal circulation has not been quantitatively investigated yet. Meanwhile pulsed doppler ultrasonography offers the possibility of estimating quantitative changes on fetal blood flow. We used both noninvasive techniques--thoracic impedance cardiography and pulsed doppler imaging system--for the simultaneous evaluation of maternal and fetal hemodynamic parameters during hypervolemic hemodilution. This preliminary report summarizes the investigations in 5 patients with pre-eclampsia (mean arterial blood pressure greater than or equal to 103.3 mm Hg, hemoconcentration with elevated hematocrit levels greater than or equal to 38%). The patients received an infusion of 500 ml dextran 40 over a period of exactly 60 minutes. The simultaneous measurements of maternal and fetal cardiovascular parameters were performed in 15-minutes intervals during dextran application and 15 minutes (p 15), 30 minutes (p 30) and 60 minutes (p 60) after the end of infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Ultrasonic Doppler method for noninvasive determination of fetal blood flow volumes].
Fetal blood flow volume and unteroplacental flow profiles can be measured with a linear real time scanner in conjunction with a pulsed Doppler system. It was the aim of this study to simulate the blood flow volume under varying experimental conditions by using an in-vitro model, and to examine and compare pulsed Doppler equipments. Defined flow rates between 200 and 1200 ml/min were pumped via a tygon tube placed in a liquid bath. The sample volume was kept constant, the depths of the tube were varied. Processing of the Doppler signals was done by spectrum analysis. There was a good correlation between true and ultrasonically measured flow rates (r = 0.96-1). However, particularly low flow rates resulted in an overestimation of blood flow when using high-pass filtering for avoiding Doppler signals arising from the vessel wall. These errors probably not only depend on the flow profiles, but also on the measuring techniques involved with the individual instruments. The effect of high-pass filtering must be taken into account when interpreting the results, particularly in the case of low-flow rates.
Blood Flow Velocity↗
[Influence of the "aliasing" effect and the filter on the quantitative determination of the mean flow rate and flow volume per unit of time using the pulsed Doppler ultrasound method].
By the pulsed doppler ultra sound the blood flow volume will be measured by a discrete time signal. The consequences which are obtained for fourier's transformation are deduced and specially the problem "aliasing" for the quantitative measurement of the flow volume per time is discussed. The influence of the different filters on the quantification of the blood flow volume per time can be demonstrated by in-vitro measurements compared with the pulsed doppler combination of Kranzbühler (pulsed Doppler combination 8105, linear 8130) and the pulsed Doppler combination of Toshiba (pulsed Doppler combination SAL 50).
Blood Flow Velocity↗
[Sonography for early detection and diagnosis of malignancy].
In clinical routine ultrasonography is suitable for identifying and differentiating genital tumours. In 95% of the cases visualization of the tumors is possible. According to shape and consistency, unsuspicious findings can be defined with 98% certainty as opposed to unknown suspiciously malignant-looking processes. Indications of malignant changes are significant in planning surgery. The introduction of a homogeneity scale from grades I to V would appear suitable to predict the dignity.
Diagnosis, Differential↗
[Pulsed Doppler procedure. Noninvasive flow measurements of the fetoplacental unit].
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Female↗
[Sonographic screening studies in pregnancy].
Actual situation of sonographic diagnostics stresses the performance of screening investigations in each trimester of pregnancy. Recommended periods are the 10th, 20th and 32nd week of gestation. The major intention of the programme consists of the assessment of abortions, fetal malformations and fetal growth retardation. The efficiency of the screening in the detection of clinically latent pathology attains 15, 0.5, and 4.5 per cent, respectively, in each trimester.
Congenital Abnormalities↗
[Sonographic criteria of ovarian function in menstruation cycles].
The sonographic equivalent of the morphological changes of the ovaries in the physiologic menstrual cycle is the periodic evidence of cystic or solid ovarian structures. The selection of the follicle destined for ovulation occurs from a number of many small antral follicles. The initial polymicro follicular reaction the timing of selection differentiates the follicular phase in the selection and in the maturation phase. The selection phase is the limiting temporal part of the cycle. The maturation occurs usually in a unifollicular manner. The daily growth of the dominant follicle (maturation rate) is in most cases not constant. Usually an intraindividual or inter-individual variability of the maturation rate of a mean 2.5 mm per day is present. Preovulatory a non significant delay in the maturation occurs. The sonographic prediction of ovulation is indirect and determined by the timing of selection, the size of the selected follicle, the maturation rate and the size of the preovulatory follicle. The diameter of the dominant preovulatory follicle is 23.1 +/- 2.8 mm. In individual cases solid structures in the preovulatory follicle are recognized which probably correspond to the cumulus oophorus. The corpus luteum structure is significantly larger than the preovulatory follicle with a size of 28.1 +/- 6.7 mm. Corpus luteum cysts can persist until the maturation phase of the next menstrual cycle. The shift from corpus luteum to dominant follicle of the next menstrual cycle can occur alternating between ovaries or homolaterally .
Corpus Luteum↗
[Sonographic studies in endocrine diseases].
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Abdominal Neoplasms↗
Ultrasonographic and hormonal studies in physiologic and insufficient menstrual cycles.
Intraovarian morphologic alterations in 6 physiologic menstrual cycles were studied by sonography and compared with 13 inadequate cycles with a short or missing luteal phase. In addition, basal body temperature, 17 beta-estradiol, luteinizing hormone, progesterone, testosterone, and dehydroepiandrosterone sulfate levels in serum were measured. The maximal follicle was significantly smaller in insufficient cycles (17.7 +/- 2.9 mm) than in physiologic cycles (23.0 +/- 2.3 mm). Corpus luteum structure was visualized in five of the six physiologic cycles but was not detected in insufficient cycles. Persistent polyfollicular reaction (greater than 3 follicles per ovary) without a dominant follicle larger than 10 mm was detected in the ovaries of three patients with clinical and hormonal signs of polycystic ovarian disease. Ultrasonography can be regarded as a useful additional tool in the evaluation and management of insufficient ovarian cycles.
Adult↗