Biomedical subjects
Publications and source records attributed to M Wikland.
Ultrasound is now an important tool for the diagnosis of tumours in the lower pelvis. Endovaginal ultrasound is being used increasingly for the diagnosis of gynaecological disease and has improved the resolution and interpretation of data. This review describes possibilities and limitations of the use of ultrasound in the diagnosis and treatment of ovarian cystic tumours.
Spermatozoa prepared for in-vitro fertilization (IVF) by swim-up in a balanced salt solution containing hyaluronate gave rates of fertilization, cleavage and pregnancy which were not significantly different from those obtained with sperm prepared by swim-up in standard IVF medium followed by centrifugation. However, the content of prostaglandin F2alpha in the final sperm suspension was higher using hyaluronate but this seemed to be of no consequence for IVF. Thus, preparation of normal sperm samples for IVF may be simplified by performing swim-up in a balanced salt solution containing hyaluronate.
Endovaginal ultrasound is a good diagnostic tool for distinguishing between cystic and solid tumors. Unilocular cysts in the lower pelvis seem to carry a very low risk of malignancy in women of all ages. Cytological evaluation of the fluid from a cystic ovarian tumor has rather poor accuracy in diagnosing malignancy. For such a reason, this study compares the diagnostic accuracy of endovaginal ultrasound to that of cytology of the cyst content. Furthermore, we wanted to determine whether irrigation after puncture of a cystic tumor could increase the number of cells in the fluid and thereby increase the diagnostic accuracy of the cytological evaluation. Fifty women admitted to surgery due to a cystic tumor were endovaginally scanned the day before surgery. After the intact tumor had been removed from the abdomen, its contents were aspirated by means of a double-channelled needle. Irrigation was performed with Ringer acetate. Cytological evaluation was performed on both portions of the cyst fluid. The negative predictive value with respect to malignancy was 77% for cytology of the first portion of the aspirate, 81% for irrigation, and 100% for ultrasound. The corresponding figures for positive predictive value were 100%, 100%, and 73%. We conclude that cytological evaluation after irrigation of a cystic ovarian tumor does not significantly increase accuracy in diagnosing malignancy compared to endovaginal ultrasound.
The content of PDGF in human blastocyst culture medium (n = 8), serum (n = 12), and FF (n = 17) from natural IVF cycles was determined by an RIA specific for PDGF B-chain. The blastocysts were cultured under serum-free conditions throughout development. The findings show that PDGF B-chain is released into the culture medium of human blastocysts and that serum is positive, whereas FF is negative for PDGF.
Effectiveness of vaginal sonography combined with urinary human chorionic gonadotropin (hCG) for identification of ectopic pregnancy (EP) was studied in 107 pregnant women. Eighty-nine women had clinical symptoms suspicious of EP. It was suggested that 18 women carried an increased risk for developing EP. In 63 women endovaginal sonography showed no evidence of intrauterine pregnancy. Fifty-eight of these turned out to be pathological pregnancies. In 44 women endovaginal ultrasonography revealed intrauterine pregnancies. Thirty-two of these turned out to be viable, 10 were not viable and resulted in spontaneous abortions, and 2 turned out to be EP. The sensitivity of vaginal sonography to identify a viable intrauterine pregnancy thus was 81% and its specificity was 97%. The sensitivity and the specificity for endovaginal ultrasonography for identifying EP was 96% and 71%, respectively. Endovaginal ultrasonography demonstrated an intrauterine gestational sac in 54% of the women with urinary HCG as low as 40 IU/L to 500 IU/L. These results show that endovaginal ultrasonography is a sensitive instrument for identifying both early normal intrauterine pregnancies as well as pathological pregnancies.
Seventy-one women who had a proctocolectomy for ulcerative colitis (n = 41) or Crohn's disease (n = 30) were interviewed in the follow-up clinic about gynaecological problems and fertility. All women were examined by an independent gynaecologist and abnormalities of the internal genital tract were registered. Forty-nine per cent (35/71) of the women had a distressing vaginal discharge after proctocolectomy, compared with 9% (6/71) before surgery. At the gynaecological examination 45% (32/71) had a heavy vaginal secretion with- out any signs of an acute vaginal infection. In 68% (30/44) fluid retention in the vagina was associated with a caudally firmly fixed and dilated posterior vaginal fornix. Twelve per cent (8/66) of the women reported dyspareunia before surgery. After surgery, 27% (18/66) complained of this symptom. Fertility was significantly reduced after surgery since only 37% (10/27) of the women who attempted to become pregnant succeeded within 5 years follow-up. The corresponding figure before surgery was 72% (39/54). Those who conceived went through pregnancy and parturition without any incident, 6 of 21 delivered by caesarean incision. In conclusion, conventional proctocolectomy in women will result in distressing vaginal discharge, and dyspareunia in a considerable proportion of the patients. The operation also seems to decrease their chances of becoming pregnant.
The value of using CA 125 for screening of ovarian carcinoma is still under debate. It is important to be aware of possible physiological variation in serum levels of this antigen. This study aimed at finding out whether there were any differences in CA 125 levels in serum at different cycle day periods of fertile women and postmenopausal women. In 106 women, CA 125 and ovarian volume were measured at different cycle day periods and in postmenopausal women. The highest levels were found in cycle day (CD) 1-9, i.e. 22 units/ml and the lowest in postmenopausal women i.e. 6.7 units/ml. No correlation could be found between the CA 125 levels and ovarian volume as measured by vaginal sonography.
Ultrasound is a sensitive tool for the diagnosis of cystic tumors in the lower pelvis of women. Most knowledge about the ultrasound image of such tumors is based on abdominal scanning. The value of vaginal sonography for evaluation of such tumors has, to the best of our knowledge, so far not been studied. This study was aimed at relating the vaginal sonographic image of tumors in the lower pelvis with the results of macro- and microscopic examination of the tumor. Special interest was paid to establishing ultrasound criteria for classifying unilocular tumors as benign or malignant. One hundred and eighty women who were operated on for pelvic tumors were included in the study. All women were evaluated by vaginal sonography the day before surgery. Ninety-four women were postmenopausal and eighty-six were still menstruating. Vaginal ultrasound characterized the tumor correctly as related to macroscopic examination in 96% (172/180). The sensitivity of vaginal sonography in identifying benign and malignant tumors was 82%, and the specificity, 92%. None of the unilocular tumors was malignant. Papillary formations on the inside of the cyst wall indicated an increased chance of the tumor's being malignant. There was a clear correlation between size of tumor and malignancy except for unilocular tumors. Vaginal sonography was shown to be accurate in characterizing cystic tumors in the lower pelvis. The present results also indicate that the probability that unilocular tumors less than 10 cm in diameter and without papillary formations, are malignant is low, irrespective of the woman's age.
The performance characteristics of time-resolved fluoroimmunoassays (FIAs) for oestradiol and progesterone were evaluated in an in-vitro fertilization/embryo transfer (IVF/ET) programme and for use in differential diagnosis of early pregnancy. Comparisons were made with commercially available radioimmunoassays (RIAs) and the correlations between the results obtained were analysed. The possible clinical impact of the differences was assessed in 30 women undergoing ovarian stimulation for IVF/ET and also in 68 women presenting with suspected pathological gestation. There was good agreement between the performance characteristics observed in the present study and those claimed by the manufacturer. There was also a strong correlation between RIA and FIA within the working ranges of the assays. The differences in the results obtained with the two methods were within the normal limits of variation of the assays, and, consequently, the clinical relevance was minimal. In conclusion, for the clinical purposes in question, the FIAs perform at least as well as commercially available RIAs, and may, therefore, be regarded as an alternative to RIAs for many laboratories.
Lidocaine is a well-documented local anaesthetic often used for paracervical block (PCB) in pregnant women. For this reason, the substance was used early on for PCB in connection with transvaginal follicle aspiration. However, the concentration reached in follicular fluid after PCB or local infiltration of the vaginal wall has not been previously determined. Furthermore, if lidocaine reaches the follicle, it seems important to determine if the concentration reached influences fertilization and early cleavage of the embryo and the pregnancy rate. The study included 46 women who had PCB with lidocaine (50 mg) and 46 women who had no PCB in connection with follicle aspiration. The mean concentration in follicular fluid was 0.36 +/- 1.1 micrograms/ml. There was no significant difference in lidocaine concentration between follicles containing oocytes that were fertilized and those that were not. Furthermore, the fertilization and cleavage rates did not differ significantly in women with and without PCB with lidocaine. The pregnancy rate did not differ between the two groups. It thus seems that the concentration of lidocaine found in the follicular fluid after PCB with 50 mg lidocaine does not negatively affect fertilization of the human oocyte or early cleavage of the human embryo.
During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. Seventy-seven percent (46/60) of the women developed no new cysts within one year of the last puncture. Thirteen percent (8/60) had to be punctured twice and 3% (2/60) three times. No complications occurred in any of the 72 punctures. Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.
Ultrasound is now frequently used for evaluation of pathological findings discovered on gynecological examination and for puncture of ovarian cysts. Although the new, high-frequency vaginal transducers have a very high resolution, only macroscopically visible structures of the tumors can be imaged. For this reason, it seemed important to classify ovarian tumors according to their macroscopic appearance and then relate this to whether the tumor was benign, borderline, or malignant. Such a classification has not been performed before. Medical records from women operated upon due to pelvic tumors over a period of 11 years were scrutinized. There were 1017 women included in the study. Among those tumors characterized as unilocular cysts 0.3% (1/296) was malignant; this tumor had macroscopically visible papillary vegetations on the inside of the cyst wall. This cyst was found in a woman 60 years old. Sixty percent (178/296) of the women who had a unilocular cyst were over the age of 40. Two percent (4/203) of the unilocular solid tumors were classified as malignant. The malignancy rates for multilocular cysts was 8% (20/229), multilocular solid tumors 36% (147/209), and solid tumors 39% (31/80). Papillary vegetation on the cyst wall was the structure that was most frequent in malignant tumors. Neither the thickness of the cyst wall nor the thickness of septa inside the tumor seemed to correlate with malignancy. Among the simple ovarian cysts, 65 had a diameter over 10 cm but none of them was malignant. The one that was malignant had a diameter of approximately 5 cm. In conclusion, unilocular ovarian cyst seems to carry a very slight chance of malignancy even in women over the age of 40. Papillary vegetation on the cyst wall, a structure that can be seen by ultrasound, seems to be a serious sign.
In our experience, as well as that of many other IVF groups, transvaginal, ultrasound-guided follicle aspiration is less invasive and comparable to, or better than laparoscopy with regard to the efficiency of oocyte recovery and safety. For these reasons, we believe that ultrasound-guided follicle aspiration will gradually become the method of choice if the only purpose is to retrieve oocytes.
The value of ultrasound in programmes of in-vitro fertilization is discussed. In order to reach the ovaries, the transvesical route was first introduced, and proved less invasive than laparoscopy. The periurethral route has also been used. The transvaginal approach, especially using a vaginal transducer with an attached needle guide, has attracted many IVF groups and is widely used today. Details of this method are presented. Ultrasound has also been used to assist in the replacement of embryos into the uterus, and the various methods are described.
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The development of vaginal ultrasound transducers has facilitated ovum pick-up (OPU) by providing higher precision and less trauma than are found with laparoscopy and other ultrasound-assisted techniques. In order to evaluate the patients' acceptance, 65 patients were asked to answer a questionnaire about their experience with the procedure. The punctures were executed with specially designed needles introduced through a needle guide attached to a vaginal transducer with a frequency of 7 MHz (Brüel & Kjaer, Denmark). The anesthesia consisted of a light premedication and a paracervical block. If needed, a small dose of sedative was given intravenously intraoperatively. The patients classified their pain experience within the day of the puncture on a four-grade scale. Their statements were compared to the physician's opinion of the discomfort caused. Oocytes were retrieved from all patients. Fifty-one patients answered the questionnaire, of whom five found the OPU painful. In two cases the physician underestimated the patients' pain experience. The mean time required for the procedure was 16 min/OPU. We conclude that transvaginal ultrasound-guided OPU is well accepted by most patients under local anesthesia and that it is a rapid and accurate procedure.
In order to evaluate the quality of ultrasound and gynecologic examination of the ovaries in women at risk for ovarian carcinoma, a group of 115 women all relatives to women with ovarian carcinoma, were examined. Although this small group of women was considered a risk group, no carcinoma was found. In premenopausal women 92% of the ovaries could be identified and measured using ultrasound. In postmenopausal women this figure was 87%, while only 30% could be identified at the gynecologic examination. This indicates that ultrasound examination of the ovaries is a much more reliable method for examining the ovary than gynecologic palpation.
Sonography has proved to be an important diagnostic and operative instrument in an in-vitro fertilization and embryo transfer (IVF/ET) program. In some IVF/ET programs the technique has even replaced laparoscopy for oocyte retrieval. To date, transvesical follicle aspiration has been the main technique for ultrasound-guided oocyte pick-up. However, this technique has some disadvantages. Therefore, we have developed a transvaginal ultrasound-guided puncturing technique. A new high-frequency vaginal sector transducer was utilized (Brüel & Kjaer). This new transducer, equipped with a needle guide, changed the oocyte retrieval into a simple, safe, and rapid procedure that can be performed under local anesthesia without any discomfort for the patient.