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Biomedical subjects

M Predanic

Publications and source records attributed to M Predanic.

At least 19 recordsLinked to original sources
PubMed2007

Short cervix: is a follow-up measurement useful?

OBJECTIVE: To study if a repeat cervical length (CL) measurement in the patient already diagnosed with a short cervix has any additional value in the prediction of preterm delivery. STUDY DESIGN: This was a retrospective study of singleton pregnancies with cervical lengths 1-25 mm at a gestational age of 16-28 weeks seen in our institution between 2002 and 2005. Patients who were managed expectantly and had a follow-up CL measurement within 3 weeks were included. Delivery data were obtained from the patients' computerized medical records. RESULTS: Sixty-eight patients met the inclusion criteria. 37% of the patients had a shorter CL on the second measurement. These patients delivered at an earlier gestational age (36+4 vs. 38+2 weeks, P=0.031) and were more likely to deliver at <37 weeks (60% vs. 26%, P=0.009). The change in the CL correlated with earlier gestational age at delivery and delivery at <37 weeks. CONCLUSION: In patients diagnosed with a short cervix, follow-up CL measurement is a strong predictor of preterm delivery. Greater change in the CL correlates with an earlier gestational age at delivery. In the patient diagnosed with a short cervix, a repeat measurement of CL gives additional predictive value.

Adult↗
PubMed2006

Antenatal umbilical coiling index and Doppler flow characteristics.

OBJECTIVE: To evaluate whether a relationship exists between the antenatal umbilical coiling index (UCI) and umbilical cord Doppler flow characteristics. METHODS: During the fetal anatomical survey in 200 consecutive pregnant patients at 18-23 weeks' gestation, we recorded umbilical coiling patterns and blood flow characteristics. The antenatal UCI, calculated as a reciprocal value of the distance between a pair of umbilical cord coils, was compared with Doppler parameters including umbilical vein blood flow volume (in mL/min/kg), and mean resistance index (RI) and peak systolic velocity (PSV in cm/s) averaged from both umbilical arteries. RESULTS: A total of 154 patients met the inclusion criteria of singleton pregnancy and having adequate sonographic umbilical cord images, Doppler flow indices, and all demographic, antenatal and labor data. The mean antenatal UCI was 0.40, with 10th and 90th centiles of 0.20 and 0.60, respectively. The mean +/- SD umbilical artery RI and PSV and umbilical vein blood flow volume were 0.74 +/- 0.07, 25.1 +/- 6.4 cm/s, and 264 +/- 106 mL/min/kg, respectively. All Doppler variables correlated significantly with antenatal UCI, with lower RI and higher PSV and umbilical vein blood flow volume values being associated with higher antenatal UCI (P = 0.016, P < 0.001, and P = 0.032, respectively). However, when stratified by antenatal UCI into hyper- (above 90th centile), normo- (10th-90th centile), and hypocoiled (below 10th centile) umbilical cord groups, a significant difference was observed for PSV only (P = 0.016). CONCLUSION: It appears that umbilical cord coiling modulates noticeably blood flow through the umbilical cord. We speculate that more prominent umbilical coiling (higher antenatal UCI values) has a protective effect on blood flow in terms of decreased arterial resistance and higher blood flow velocities, as well as increased venous blood flow. However, due to lack of significant differences between Doppler characteristics when stratified by antenatal UCI into hypo-, normo-, and hypercoiled groups, the clinical implications of this observation are uncertain.

Adolescent↗
PubMed2004

Intraobserver and interobserver reproducibility of fetal biometry.

OBJECTIVE: To assess the intra- and interobserver reproducibility of ultrasound measurements of fetal biometric parameters. METHODS: We assessed the intraobserver and the interobserver agreement in measurements of fetal biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC) and femur length (FL) on 122 singleton pregnancies. Patients were each examined twice by the first sonographer to determine the intraobserver reliability of measurements of fetal biometry. Subsequently, during the same ultrasound examination, a second blinded sonographer measured fetal biometric parameters to assess interobserver reliability. The consensus between and among observers was analyzed using the intraclass correlation coefficient (intra-CC) and interclass correlation coefficient (inter-CC) and the reliability coefficients (RC, alpha) for the four biometric measurements. A value > 0.75 was considered a reliable consensus for the intra-CC and inter-CC. A Bland and Altman plot was also created for the fetal biometric parameters to assess the repeatability of the measurements. RESULTS: Reliable consensus was observed for both the intra-CC and inter-CC and RC for all four biometric parameters. The intra-CC with the 95% CI and RC for the BPD, AC, HC and FL were as follows: 0.996 (0.995, 0.997), alpha 0.998; 0.994 (0.992, 0.996), alpha 0.997; 0.996 (0.994, 0.997), alpha 0.998; and 0.994 (0.992, 0.996), alpha 0.997, respectively. Similarly, the inter-CC with the 95% CI and RC for the same parameters were as follows: 0.995 (0.993, 0.997), alpha 0.998; 0.980 (0.971, 0.990), alpha 0.990; 0.994 (0.992, 0.996), alpha 0.997; and 0.990 (0.985,0.993), alpha 0.995, respectively. The Bland and Altman plots demonstrated a high degree of repeatability of BPD, AC, HC, and FL measurements. CONCLUSION: Our results demonstrate that the intra- and interobserver reproducibility of ultrasound measurements of fetal biometry are highly reliable.

Abdomen↗
PubMed2000

Differentiating tubal abortion from viable ectopic pregnancy with serum CA-125 and beta-human chorionic gonadotropin determinations.

OBJECTIVE: To determine whether serum CA-125 and serial beta-hCG levels can be used to distinguish between tubal abortion and viable ectopic pregnancy (EP). DESIGN: Retrospective cohort study. SETTING: A tertiary care institution. PATIENT(S): Twenty-six women with EPs of 7-12 weeks' duration were studied retrospectively. Five had laparoscopically proved tubal abortions and 21 had active, viable EPs at the time of entry into the study. All but 3 of the latter group were managed surgically; the others were given a single dose of methotrexate. INTERVENTION(S): Surgical removal of EPs by means of laparoscopy or laparotomy, or medical treatment of the disease. MAIN OUTCOME MEASURE(S): Serum CA-125 and beta-hCG determinations were used to differentiate tubal abortion and viable EP. The results were compared with the findings at surgery. RESULT(S): The mean (+/-SD) CA-125 level was 112.2 +/- 11.9 IU/mL for the patients with tubal abortion and 30.1 +/- 15.3 IU/mL for the patients with viable EP. The mean (+/-SD) beta-hCG level was 3,643 +/- 3,718 IU/L for the patients with tubal abortion and 10,755 +/- 11,465 IU/L for the patients with viable EP. Linear regression analysis showed a statistically insignificant inverse relation between serum CA-125 and beta-hCG levels. CONCLUSION(S): The use of CA-125 levels as an adjunct to serial beta-hCG levels shows promise as a means for differentiating tubal abortion from viable EP.

Abortion, Spontaneous↗
PubMed1998

Disparate blood flow patterns in parallel umbilical arteries.

OBJECTIVE: To compare resistance to blood flow between two umbilical arteries at the same cord site during the second half of pregnancy. METHODS: We evaluated 80 patients with singleton pregnancies cross-sectionally at gestational ages ranging from 20-40 weeks' gestation. Resistance to blood flow was measured separately by means of systolic-diastolic ratio (S/D) for both umbilical arteries of each subject at the same site of transverse cord section. The higher mean value of the one umbilical artery was designated S/Dmax, whereas the lower mean value of the other paired umbilical artery was designated S/Dmin. The percent difference between the two values was calculated for each pair of measurements. Then these data were stratified by gestational age. RESULTS: The overall mean (+/- standard deviation [SD]) S/Dmax was significantly different from S/Dmin (2.62 +/- 0.58 versus 2.27 +/- 0.40, respectively P < .001). The mean (+/- SD) calculated percent difference of 14.9 +/- 10.4% ranged in a downward trend over the course of late pregnancy from 29.2 +/- 17.1% in the 20-28 weeks' gestational age group to 10.4 +/-6.1% among those at term (37-40 weeks); the slope of this trend was -1.32 +/- 8.55% per week, a statistically significant trend (P < .001). There was a more than 20% difference in more than one quarter (29%) of the 80 pairs of umbilical arteries we studied. Cases with these large differences were concentrated mostly among those with earlier gestational ages: At term, only 8.6% showed this difference in flow resistance measurements. CONCLUSION: The resistance to blood flow in one umbilical artery often differs considerably from that in the other. The difference, which equalizes gradually as pregnancy advances, perhaps as a result of functional maturation of the Hyrtl anastomosis between the vessels, may have clinical importance for identification and evaluation of the potentially jeopardized fetuses, either as an early marker of fetal hypoxia or in interpretating fetal status.

Adult↗
PubMed1998

Correlation of serum estrogen levels with uterine and carotid arteries flow in postmenopausal women on hormone replacement therapy.

OBJECTIVE: To determine the pattern of blood flow in the patients compliant and non-compliant to hormone replacement therapy. METHODS: In the period of 12 months, 106 postmenopausal women were examined by the color and pulsed Doppler ultrasonography of the blood flow through uterine, common, and internal carotid arteries (Resistance Index, RI). The study was retrospective-descriptive. Patients were divided into three groups: (1) 38 patients compliant with hormone replacement therapy and daily using Premarin/Provera, (2) 27 patients non-compliant with the treatment because of discontinuation of the therapy and/or irregular use of medicine, and (3) control group of 41 women who never used hormone replacement therapy. Results were compared with serum estrogen (E2) drawn on the day of the blood flow assessment. RESULTS: Mean E2 serum concentration in the hormone replacement therapy-compliant group was 90.1 pg/mL, 45.5 pg/mL in the non-compliant group, and 26.6 pg/mL in the control group (p<0.01). Serum E2 concentration correlated with the decrease in resistance to blood flow in the uterine artery (p=0.001), but did not in the common carotid (p=0.34) and internal carotid arteries (p=0.66). The compliant group and control group differed in the uterine artery blood flow (RI 0.78 vs. 0.87, respectively). CONCLUSION: Differences in E2 serum concentration between the groups are related to the hormone replacement therapy and the patients' compliance to the therapy. Small peripheral arteries readily respond to the serum E2 levels, whereas large peripheral arteries (common and internal carotid) are too "rigid" to respond to E2-induced vasodilatation.

Adult↗
PubMed1996

Color and pulsed Doppler sonography, gray-scale imaging, and serum CA 125 in the assessment of adnexal disease.

OBJECTIVE: To compare color and pulsed Doppler sonography with gray-scale ultrasound imaging and serum CA 125 levels in establishing accurate preoperative diagnoses of adnexal masses. METHODS: Medical records of 109 patients referred with preexisting adnexal lesions were reviewed retrospectively by comparing preoperative ultrasonic data (gray-scale imaging and color and pulsed Doppler findings) with serum CA 125 levels. RESULTS: Eighty-three masses were removed surgically, confirming seven malignancies and 76 benign tumors, and 26 masses were followed; 15 regressed and 11 persisted. Color and pulsed Doppler sonography showed the highest sensitivity, followed by gray-scale imaging, whereas serum CA 125 levels revealed the highest specificity in distinguishing malignant from benign adnexal tumors. All three methods had high negative predictive values (96-100%), whereas only serum CA 125 had a positive predictive value greater than 50%. CONCLUSION: Color and pulsed Doppler sonography, which demonstrate a tumor angiogenic activity, are as accurate as gray-scale imaging in the assessment of adnexal lesions. Together with serum CA 125 marker levels, they produce high negative predictive values, providing reassurance that an adnexal mass is benign.

Adnexal Diseases↗
PubMed1996

Transvaginal color Doppler determination of the ovarian and uterine blood flow characteristics in polycystic ovary disease.

OBJECTIVE: To determine blood flow characteristics of ovarian and uterine arteries in patients with endocrinologically and clinically confirmed polycystic ovary disease (PCOD) in comparison with blood flow parameters observed in patients with spontaneous ovulatory cycles. DESIGN: Controlled clinical study. SETTING: Patients from Infertility Service in a tertiary care institution. PATIENTS: Forty patients with confirmed PCOD and 50 control patients in various phases of spontaneous menstrual cycles. MAIN OUTCOME MEASURE: Using transvaginal color Doppler sonography to determine ovarian morphology, ovarian blood vessel visualization rates, and ovarian and uterine arteries blood flow parameters (resistance index, pulsatility index, and maximal peak velocity). These parameters were correlated with serum hormone levels. RESULTS: Polycystic ovaries showed typical vascular pattern: increased stromal vascularity, a positive correlation between increased blood velocities and serum LH levels, and a trend toward lower resistance index and pulsatility index values, whereas uterine arteries revealed significantly increased resistance index and pulsatility index values. CONCLUSIONS: The observed specific intraovarian and uterine vascular pattern in PCOD patients may provide additional data for conventional endocrinologic and ultrasonic diagnostic methods for PCOD.

Adolescent↗
PubMed1995

The role of color Doppler in diagnosis of endometriomas.

The aim of this study was to characterize the appearance of the vascular pattern of endometriomas in terms of color Doppler and to verify the role of Doppler flow indices in differentiating endometriomas from other pelvic masses. Twenty patients with suspected endometriosis were referred for evaluation and surgical management of adnexal masses and/or infertility problems. Before surgery, transvaginal sonography was performed using an Ultramark 9 (ATL) Ultrasound system. The color Doppler was used for evaluation of the vascular color distribution. Flow parameters (resistance index (RI) and pulsatility index (PI) were obtained using pulsed Doppler. A total of 24 masses were identified in the 20 patients studied. Sixteen masses proved to be endometriomas, with a mean size of 3.5 +/- 0.4 cm. Of confirmed endometriomas, 81% had a regular internal surface and 63% showed the characteristic homogeneous low-level echoes filling the cyst. Eleven of 16 (69%) endometriomas showed flow by color Doppler. The flow was characteristically limited, with few spots of vascular color seen in each mass. Cases that showed dense vascularity with color Doppler proved not to be endometriomas. The mean +/- SE of the RI and PI for the endometriomas were 0.59 +/- 0.02 and 0.95 +/- 0.1, respectively. All endometriomas showed an RI of > 0.5 with a range of 0.5-0.74, while the PI was 0.59-1.59. No significant differences between flow indices for endometriomas and other benign cystic lesions were noted. Scattered vascularity, one feature of adnexal endometriomas, may help to differentiate them from other lesions of dense vascular distribution, such as corpora lutea or ovarian neoplasms.

Endometriosis↗
PubMed1995

The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography.

The objective of this study was to correlate, during 12 weeks of therapy with gonadotropin releasing hormone agonist (GnRH-a), the chronological effect and the hemodynamic changes on the uterine artery and the leiomyometrial supplying vessels. Twenty-three premenopausal women with clinically diagnosed uterine leiomyomas received 3.75 mg of leuprolide acetate intramuscularly every 4 weeks for 12 weeks. Pretreatment values of serum estradiol, uterine and leiomyoma volumes and blood flow characteristics of the main uterine artery and leiomyoma supplying vessels-resistance index (RI), pulsatility index (PI) and peak-systolic velocity, obtained by transvaginal color Doppler sonography-were compared with treatment values at 4, 8 and 12 weeks of leuprolide acetate therapy. The first event in the chronological response to the GnRH-a therapy was a statistically significant increase in RI and PI values for major leiomyoma vessels, observed at the end of the 4th week (p < 0.05), which increased significantly after 8 and 12 weeks (p < 0.01 and p < 0.001, respectively). These findings were in direct correlation with a significant decrease of estradiol levels after 4, 8 and 12 weeks (p < 0.05, p < 0.001 and p < 0.001, respectively). The significant decrease of blood flow in the leiomyometrial vessels was followed by a significant decrease of the main uterine artery blood flow after 8 weeks and uterine and leiomyoma volumes by 42% and 55%, respectively, after 12 weeks of GnRH-a therapy. We concluded that a significant increase in leiomyometrial vessels RI and PI values, which was found 4 weeks after the first dose of GnRH-a, but without major leiomyoma volume decrease, emphasizes that the first significant effect of GnRH therapy in the process of uterine and leiomyoma volume shrinkage is the reduction of leiomyometrial rather than uterine blood flow. This effect is followed by a considerable reduction of uterine vascularity and a significant decrease of uterine and leiomyoma volumes. If a decrease of blood loss during myomectomy is the main aim of GnRH-a therapy, we believe that 8 weeks would be an appropriate therapy duration.

Adult↗
PubMed1995

Transvaginal color and pulsed Doppler sonography of the endometrium: a possible role in reducing the number of dilatation and curettage procedures.

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal.

Transvaginal color Doppler ultrasonography was used to study 131 normal early pregnancies, 30 molar pregnancies, 20 threatened abortions, two blighted ova, and five pregnancies with intramural myoma. Four separate parts of the maternal circulation were studied: uterine, arcuate, radial, and spiral arteries. There was statistical difference in the RI and PI among uterine, arcuate, radial, and spiral arteries (P < 0.001) in all observed groups of patients except those with intramural myoma. When the same part of the maternal circulation was compared among different groups of patients, the following results reached statistical significance: uterine artery in normal and molar pregnancy (P < 0.001); arcuate artery in normal and molar pregnancy (P < 0.001); radial artery in normal and molar pregnancy (P < 0.001) and in normal pregnancy and threatened abortion (P < 0.01); spiral artery in normal and molar pregnancy (P < 0.001), in normal pregnancy and threatened abortion (P < 0.01), and in molar pregnancy and threatened abortion (P < 0.01). The standard values of blood flow are different in normal and in some cases of abnormal early pregnancy (molar pregnancy, threatened abortion).

Abortion, Threatened↗
PubMed1994

Fetal choroid plexus vascularization assessed by color flow ultrasonography.

We investigated the development of intracranial vascularization in the human fetus, with particular emphasis on the choroid plexus. The fetal brain was visualized in 102 patients with healthy pregnancies between 9 and 16 weeks' gestation. Imaging was done transvaginally except in the pregnancies of longer duration with unfavorable fetal positions. Color flow imaging was used to identify vessels in the cranium and within the choroid plexus. Pulsed Doppler signals were obtained from an internal carotid-middle cerebral artery and from a choroid plexus vessel. The pulsatility index was calculated from the Doppler spectral envelope. A major cerebral vessel could be seen at 9 weeks' gestation. Choroid plexus vessels were first seen at 10 weeks 3 days. Visualization rates ranged from 35 to 75% for plexus vessels, and 65 to 100% for cerebral vessels. Visualization of choroid plexus vessels was maximal at 13 weeks. The pulsatility index for the cerebral arteries at this gestational period averaged 2.6 +/- 0.6. The result for the choroid plexus was 1.66 +/- 0.5. (P < 0.001). Visualization of the vessels of the choroid plexus increases and decreases as the gland develops and shrinks. This developmental period also is the time of active neurogenesis.

Adult↗
PubMed1994

An attempt to screen asymptomatic women for ovarian and endometrial cancer with transvaginal color and pulsed Doppler sonography.

Several screening procedures have been proposed to detect ovarian and endometrial cancer. However, none of them is sensitive and specific enough to be used in population-based screening programs. During our 5 year long study, 5013 asymptomatic women (44% premenopausal and 56% postmenopausal women) were scanned by transvaginal color and pulsed Doppler ultrasonography in an attempt to detect malignancy. These women had 404 adnexal cysts; 70 had resolved spontaneously on follow-up scans and 18 persisted. Another 316 sonographically benign cysts are still in the procedure of follow-up second scans. Of 5013 women, four women had stage I ovarian carcinoma and six had stage I endometrial carcinoma. There was one false-positive case encountered with an endometrioma. Only 14 women were subjected to major operative intervention; others underwent minor procedures based on the benign scan findings. No medical or surgical complications were reported. Transvaginal color Doppler ultrasonography, a noninvasive procedure, can detect ovarian and endometrial carcinoma in asymptomatic women and may be used as a screening procedure for these diseases.

Endometrial Neoplasms↗
PubMed1994

Transvaginal color Doppler in early pregnancy: rational and clinical potential.

Remarkable hemodynamics changes that occur in the maternal circulation, the continuous growth and development of the feto-placental circulation is now studied by transvaginal Doppler. This seems to give more light in understanding of the early pregnancy pathophysiology. For the first time, it seems that ultrasound might be able to distinguish different forms of gestational trophoblastic disease. Due to its non-invasiveness and relatively simple and easily performed technique, transvaginal color Doppler might be of considerable clinical value. The other important point is that study results are available immediately for clinical judgement. From our study, we can conclude that transvaginal ultrasound with color and pulsed Doppler is potentially valuable diagnostic tool to differentiate forms of the gestational trophoblastic diseases. On the basis of Doppler findings, the complete mole can be reliably distinguish from the invasive mole or choriocarcinoma. The degree of myometrial invasion can be also assessed. This can be an objective foundation for therapeutical approach. There is no doubt that studies of maternal-fetal circulation in early pregnancy may help for better understanding of physiological and pathophysiological hemodynamic changes. Investigation of maternal (main uterine, arcuate, radial and spiral) arteries; placental (umbilical, chorionic arterioles) vessels and fetal (aorta and intracranial circulation) arteries flow patterns may help in order to diagnose abnormal implantation. More studies are necessary in order the Doppler technique to be used for clinical judgment in early pregnancy. Safety aspects should also be considered. However, potentials of these technique are more then obvious.

Corpus Luteum↗
PubMed1994

Ovarian cancer screening.

To reduce the mortality from ovarian cancer various studies by transvaginal color Doppler (TVCD) sonography and serum CA-125 tumor marker, alone or in combination, have been performed. Relatively poor specificities of CA-125 and transvaginal conventional sonography can be improved with the use of TVCD. Furthermore, high specificity can be achieved on screening asymptomatic postmenopausal women by combining serum CA-125 measurement with TVCD. Combining tests should not necessarily increase the overall cost of screening because of the expected decrease in the number of unnecessary surgical interventions. Until the results of large, prospective studies are available, the efficacy of potential tests for screening of ovarian cancer will remain unproven and they should not be used to screen apparently healthy women outside of scientific interest.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1993

Characteristics of blood flow in cancer of the uterine cervix.

Blood flow characteristics were measured in patients with histologically proved cervical cancer and compared to normal values. Flow parameters were derived by color and pulsed Doppler ultrasound. The results showed a significant difference in the mean values of resistance index and pulsatility index among the diseased patients and healthy controls. However, the method does not have the required sensitivity for screening purposes, so that its value may mainly be in the follow-up of patients treated conservatively with radiation and chemotherapy.

Journal Article↗