[Endoluminal ultrasonography of the anal canal].
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Biomedical subjects
Publications and source records attributed to J F Pedersen.
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Twenty-four women with primary suture of an obstetric tear of the anal sphincter were examined with anal endosonography a median of 12 (range 3-18) months after delivery. Endosonography was normal in ten patients, of whom one was incontinent. The examination showed a defect in the external anal sphincter in 13 patients; six of these were incontinent, two of whom had normal findings on palpation. An isolated internal sphincter defect was found in a continent patient. Since anal endosonography causes no more discomfort than digital examination, it may be useful to identify patients who would benefit from surgical reconstruction of the anal sphincter.
OBJECTIVE: To investigate whether fetal weight estimation by ultrasound in diabetic pregnancy might be based upon fetal abdominal circumference (AC) alone. DESIGN: A retrospective study. SETTING: Diabetes Center, Rigshospitalet and Ultrasound Laboratory, Glostrup Hospital, Copenhagen. SUBJECTS: Eighty-six diabetic pregnant women who had an ultrasound study within 2 days before delivery. RESULTS: We assessed in 73 fetuses various formulas based upon biparietal diameter and AC against formulas based upon AC alone, and these were only marginally less effective than the more complex ones. In 86 fetuses an AC was available. These fetuses were divided into a study population and a test population. The linear model was customized for the study population. Evaluation on the test population showed that the relative error (error as a percentage of birthweight) in predicting birthweight had a standard deviation of 7.8%. The efficacy of AC in detecting fetuses greater than 4000 g was examined in the test population: If AC greater than 36.0 cm was chosen as criterion for macrosomia the positive and negative predictive values were 80% (8/10) and 91% (30/33), respectively. CONCLUSION: Formulas for estimating fetal weight in diabetic pregnancy based on AC alone are almost as effective as more complex ones. We recommend a simple linear formula of fetal weight as a function of AC.
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The anal sphincter muscles consist of the circular internal and external sphincters together with the sling-shaped associated puborectalis muscle. Ten men, 10 women with no vaginal deliveries, and 10 women with one or more vaginal deliveries were studied with anal endosonography using a 7 MHz multiplanar endoprobe. The thickness of the internal sphincter and the thickness, length, and cross-sectional area of the external sphincter were measured and related to age, sex, and parity. Reproducibility was assessed by similar measurements on different days in 10 volunteers. Anal sphincter size was the same in men and women and was not affected by the number of child births. Internal sphincter muscle thickness increased with age. Anal manometry and electromyography with an anal sponge were performed in all volunteers but the results did not correlate to any of the anal sphincter dimensions. Our conclusion is that although there are some limitations, endosonography can be used to determine the size of the anal sphincter muscles.
The decidualized endometrium produces secretory proteins of which secretory endometrial protein PP14 is the major product during the first trimester of pregnancy. The protein is secreted into the uterine lumen as well as into the peripheral blood. The purpose of this study was to examine whether decidual function, evaluated by the serum concentration of PP14, was different in women with early pregnancy bleeding compared to normal pregnant women. A reference range for serum PP14 was established on the basis of single samples from 236 normal pregnant women with ultrasonically confirmed gestational age. All the women were delivered of a normal child at term. The study comprised 128 pregnant women admitted because of vaginal bleeding between 6 and 18 weeks gestation. At ultrasonography, intrauterine fetal heart activity was either present or was confirmed at a subsequent examination. No difference was found in the serum level of PP14 compared to that in normal pregnancies, but women with vaginal bleeding and depressed PP14 levels appeared to have a 5-fold higher risk of preterm delivery than women with bleeding and normal PP14 levels.
The self-retaining intra-urethral device "Prostakath" was inserted in a consecutive series of 29 men with obstructive benign prostatic hypertrophy. Fifteen patients were relieved of prostatic symptoms for an observation period of 22 weeks (range 2-60). The spiral was removed in 14 cases (48%) at an average of 14 weeks (range 1-82) after insertion; in 9 patients this was because of urinary retention and in 5 it followed dislocation of the stent into the bladder. Five stents removed after 44 weeks of treatment (range 21-82) were severely calcified. Light microscopic investigation of the Spirals that were removed revealed no damage to the gold-plated surface. All patients with calcification had chronic urinary infection resistant to antibiotic treatment. We believe that infected urine is the major factor responsible for the calcification. We suggest that patients with recurrent urinary infection after insertion of the Prostakath should be closely followed up and checked for stone formation by a plain X-ray of the bladder region. It may be advisable to change the Prostakath in patients with resistant urinary tract infection at 6-monthly intervals.
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Knowledge of the normal sonographic features of the anal canal is essential for the detection of anal carcinomas, anal sphincteric defects, or other anal abnormalities with endosonography. The anal sphincters consist of the circular smooth muscle fibers of the internal sphincter and the circular striated muscle fibers of the external sphincter together with the sling-shaped puborectalis muscle. Anal endosonography was performed in 14 healthy women with normal anophysiologic examinations. The procedure was performed during electromyographic registration in five. A radial 7-MHz probe and a multiplane 7-MHz probe were used, and transverse and longitudinal images were obtained. On transverse images, the internal anal sphincter was visualized as a circular hypoechoic band, which on longitudinal images was seen in continuity with the muscularis layer of the rectal wall. The external anal sphincter was seen as a thicker circular echogenic band just outside the internal sphincter. The puborectalis muscle sling, which is the medial part of the levator and muscle, was visualized in the upper anal canal and had the same echogenic appearance as the external sphincter. Our experience in volunteers provides information about the normal sonographic features of the anal canal as depicted on anal endosonography with high-frequency probes. The results suggest the procedure may be a useful diagnostic tool in detecting pathologic conditions in the anal canal.
An uncommon sonographic pattern was observed in 2 dermoid cysts. An echogenic upper and an echo-free dependent component were separated by a horizontal delineation, an observation that could be reproduced in a laboratory model. We believe that this finding is pathognomonic for a dermoid cyst.
Previously we described intrauterine haematomata seen with ultrasound in patients with threatened miscarriage and we suggested that a haematoma of greater than or equal to 50 ml might represent a risk to the pregnancy. We have now investigated 566 patients with vaginal bleeding in the first half of pregnancy and followed up 23 (4%) who had a haematoma of greater than or equal to 50 ml (mean 71 ml, range 50-150) at between 12 and 20 weeks gestation. One patient had a miscarriage and two had a preterm delivery, so that, contrary to our original suggestion, these large haematomata do not seem to represent any serious threat to the pregnancy.
We performed a prospective study to determine the prevalence and significance of subchorionic hematomas in patients with symptoms of threatened abortion. The study comprised 342 pregnant women who had vaginal bleeding in weeks 9-20 of pregnancy and a live fetus shown with sonography. Sonograms showed a subchorionic hematoma in 62 patients (18%). The average size of the hematoma was 20 ml (range, 2-150 ml). The rate of spontaneous abortion was the same in patients with and without hematoma, seven (11%) of 62 and 28 (10%) of 280, respectively. There was no association between abortion rate and hematoma size. The rate of premature delivery was the same in patients with and without hematoma, seven (11%) of 62 and 32 (11%) of 280, respectively. There was no association between the rate of premature delivery and hematoma size. Subchorionic hematomas are common and insignificant sonographic findings in patients with vaginal bleeding in weeks 9-20 of pregnancy.
Depressed pregnancy-associated plasma protein A (PAPP-A) concentrations have been found in patients with threatened abortion, often weeks before spontaneous abortion while the fetus was still alive. In order to extend these findings we have developed a highly sensitive PAPP-A radio-immunoassay and have established a reference range in early pregnancy for PAPP-A between week 7 and week 20 of pregnancy, based on blood samples from 240 pregnant women. The gestational age was determined by ultrasound. PAPP-A was measured in 128 women admitted to hospital because of vaginal bleeding in the 7th to 20th gestational week. The viability of the fetus was confirmed by ultrasonography. The serum values of PAPP-A were significantly lower (p = 0.002) in the group of women with vaginal bleeding than in the group of normally pregnant women. However, with regard to abortion later on, the predictive value of an abnormal blood test on admission was only 18.7%. Serial determinations showed increased PAPP-A values corresponding to the centile expected in the 12 women who aborted, as well as in the 116 women who gave birth. Consequently, the test is of no clinical value in the assessment of the prognosis in patients with symptoms of threatened abortion.
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Ninety nine consecutive insulin dependent and 101 non-diabetic pregnant women were examined by ultrasonograph to assess early fetal growth. In 42 of the diabetic mothers and three of the non-diabetic mothers the scan showed early intrauterine growth delay. At 4-5 years of age all children available for study were evaluated by the Denver developmental screening test. Only 23 of the 34 children of diabetic mothers with early intrauterine growth delay had normal test scores compared with 46 of the 50 children of diabetic mothers with normal intrauterine growth. The children failed in personal-social development, gross motor development, and particularly in language and speech development. Children of diabetic mothers with normal early fetal growth had scores very similar to those of the children of non-diabetic mothers, of whom 76 of the 86 tested had normal scores. This study suggests that children with a history of growth delay in early diabetic pregnancy should be screened for possible developmental impairment.
Three-hundred fetal crown-rump length (CRL) measurements in the range 10-80 mm and 245 measurements of biparietal diameter (BPD) in the range of 17-50 mm were obtained in a longitudinal study of 105 pregnancies. The width of the 95% prediction interval for age estimates was established for 10 mm ranges of CRL and BPD. The prediction interval was most narrow (+/- 4 days) in week 11 (CRL measurements from 31 to 40 mm) and from then on increased with increasing age. In the period in which both CRL and BPD could be measured, weeks 13 and 14, the prediction interval was identical for the two (+/- 6 days), so that the most feasible ultrasound measurement could be chosen.
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To assess whether sulfated gastrin contributes to the cholecystokinetic and pancreozymic activity of plasma in humans, 8 healthy subjects on separate days received a mixed meal, graded i.v. infusions of synthetic human tyrosine-O-sulfated gastrin 17 (10.9, 32.7, and 98.1 pmol/kg X h), which was compared with nonsulfated gastrin 17 (12.2, 36.6, and 109.8 pmol/kg X h) and O-sulfated cholecystokinin-octapeptide (5.5, 16.5, and 49.5 pmol/kg X h). Gallbladder volumes were measured by ultrasonography, and the concentrations of gastrin and cholecystokinin in the circulation were determined by specific radioimmunoassays. Neither of the gastrins induced changes in gallbladder volume at serum concentrations occurring postprandially, whereas cholecystokinin-octapeptide produced a significant reduction in gallbladder volume even at a plasma cholecystokinin concentration lower than observed postprandially. Another 8 subjects received the same infusions in combination with a background infusion of synthetic secretin (0.3 CU/kg X h). Gastric and duodenal juice was continuously aspirated using a double-marker perfusion technique. Neither of the gastrins caused an increase in the output of amylase, lipase, trypsin, chymotrypsin, or bilirubin, but both induced a modest increase in the output of bicarbonate and duodenal juice, the former only significantly during infusion of sulfated gastrin 17. The output of all parameters was significantly elevated during all doses of cholecystokinin-octapeptide. The results indicate that neither of the gastrins stimulates gallbladder contraction and pancreatic enzyme secretion in humans under physiologic conditions. However, gastrin may, like cholecystokinin, potentiate the effect of secretin on pancreatic secretion of juice and bicarbonate.