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T Van den Bosch

Publications and source records attributed to T Van den Bosch.

At least 19 recordsLinked to original sources
PubMed2006

First trimester diagnosis of sirenomelia.

We present a case of sirenomelia diagnosed on a first trimester ultrasound at 10 weeks' gestation and confirmed on 3D-ultrasound and MRI. The pregnancy was terminated at 15 gestational weeks and the post-mortem examination, including RX and microscopy, is presented. The sirenomelia sequence is a rare and lethal anomaly characterized by fusion, rotation, hypotrophy or atrophy of the lower limbs and severe urogenital abnormalities leading to oligohydramnios in the second half of pregnancy. Our case illustrates that the diagnosis of sirenomelia can be reliably made in the first trimester.

Abortion, Eugenic↗
PubMed2006

New models to predict depth of infiltration in endometrial carcinoma based on transvaginal sonography.

OBJECTIVES: Preoperative knowledge of the depth of myometrial infiltration is important in patients with endometrial carcinoma. This study aimed at assessing the value of histopathological parameters obtained from an endometrial biopsy (Pipelle de Cornier; results available preoperatively) and ultrasound measurements obtained after transvaginal sonography with color Doppler imaging in the preoperative prediction of the depth of myometrial invasion, as determined by the final histopathological examination of the hysterectomy specimen (the gold standard). METHODS: We first collected ultrasound and histopathological data from 97 consecutive women with endometrial carcinoma and divided them into two groups according to surgical stage (Stages Ia and Ib vs. Stages Ic and higher). The areas (AUC) under the receiver-operating characteristics curves of the subjective assessment of depth of invasion by an experienced gynecologist and of the individual ultrasound parameters were calculated. Subsequently, we used these variables to train a logistic regression model and least squares support vector machines (LS-SVM) with linear and RBF (radial basis function) kernels. Finally, these models were validated prospectively on data from 76 new patients in order to make a preoperative prediction of the depth of invasion. RESULTS: Of all ultrasound parameters, the ratio of the endometrial and uterine volumes had the largest AUC (78%), while that of the subjective assessment was 79%. The AUCs of the blood flow indices were low (range, 51-64%). Stepwise logistic regression selected the degree of differentiation, the number of fibroids, the endometrial thickness and the volume of the tumor. Compared with the AUC of the subjective assessment (72%), prospective evaluation of the mathematical models resulted in a higher AUC for the LS-SVM model with an RBF kernel (77%), but this difference was not significant. CONCLUSIONS: Single morphological parameters do not improve the predictive power when compared with the subjective assessment of depth of myometrial invasion of endometrial cancer, and blood flow indices do not contribute to the prediction of stage. In this study an LS-SVM model with an RBF kernel gave the best prediction; while this might be more reliable than subjective assessment, confirmation by larger prospective studies is required.

Aged↗
PubMed2005

Ultrasound examination of the endometrium before and after Pipelle endometrial sampling.

OBJECTIVE: To evaluate if, and to what extent, Pipelle de Cornier endometrial sampling influences the ultrasonographic features of the endometrium. METHODS: This was a prospective descriptive study on 99 consecutive women in whom a Pipelle endometrial biopsy was performed. All patients first underwent a transvaginal ultrasound evaluation of the uterus. The endometrial thickness (ET) was measured and endometrial sonographic features were recorded. Thereafter, a Pipelle endometrial biopsy was taken. Finally, the ultrasound examination was repeated. The patients' characteristics, the sampling procedure, the endometrial histology and the sonographic findings before and after Pipelle biopsy were compared. RESULTS: Ninety-nine women, of whom 45% were postmenopausal, entered the study. The mean age was 59.0 years (SD, 9.9) for the postmenopausal women, and 41.6 years (SD, 8.7) for the rest. On histological examination, endometrial cancer was diagnosed in four patients and endometrial hyperplasia in eight patients. The average ET before Pipelle sampling was 9.0 mm (SD, 6.6) vs. 8.6 mm (SD, 7.0) after biopsy (P < 0.0001). After Pipelle sampling, the endometrium was less clearly delineated (P = 0.03) and more echogenic endometrial spots were seen (P < 0.0001). If an endometrial three-layer pattern was noted before sampling, it was not observed in most women after Pipelle biopsy (P = 0.0003). CONCLUSIONS: ET measurements are affected by Pipelle sampling and the quality of the ultrasound features tends to be altered by biopsy. Performing the ultrasound examination before proceeding with endometrial sampling may therefore improve diagnostic accuracy of ultrasound.

Adult↗
PubMed2004

Prospective evaluation of blood flow in the myometrium and uterine arteries in the puerperium.

OBJECTIVE: Heavy bleeding in the late postpartum has, in some cases, been attributed to subinvolution of the placental bed and enhanced myometrial vascularity (EMV) as seen on color Doppler imaging. The aim of this study was to investigate the incidence and spontaneous evolution of areas of enhanced vascularization over the whole thickness of the myometrium in asymptomatic women after uncomplicated term pregnancy. METHODS: This was a prospective descriptive study involving 93 consecutive women who were examined on day 3 (mean 2.6 +/- 1.5) and at 6 weeks (mean 6.5 +/- 1.3) after delivery following an uncomplicated term pregnancy. EMV was defined as the presence of marked flow over the full thickness of the myometrium reaching the uterine cavity. Doppler flow examination within the area of EMV and of both uterine arteries was performed. RESULTS: The mean patient age was 29.1 years and average parity was 1.7. The mean gestational age at delivery was 39.1 weeks. Areas of EMV were visualized in 50.5% of patients on day 3 vs. 3.9% at 6 weeks. None of the patients required therapy for bleeding problems. The mean pulsatility index and peak systolic velocity in the area of EMV on day 3 were 0.45 +/- 0.30 and 0.37 +/- 0.20 m/s, respectively. A consistent increase in vascular resistance and decrease in blood flow velocity was observed in both uterine arteries between day 3 and week 6. CONCLUSIONS: Most areas of EMV reflect intermediate stages in the involution of the placental bed and do not cause abnormal postpartum bleeding. EVM is common in the puerperium, disappears spontaneously in the vast majority of cases, and does not warrant treatment if asymptomatic. Further research is needed to predict the rare cases in which subinvolution of the placental bed leads to heavy bleeding in the late postpartum.

Adult↗
PubMed2003

Uterine intramural bone after mid-trimester termination of pregnancy may not affect fertility: a case report.

We present a case of a 27-year-old asymptomatic woman, gravida 2 para 0 abortus 2, diagnosed with uterine intramural fetal bone 30 days after a mid-trimester termination of pregnancy (TOP) by dilatation and evacuation (D&E). On ultrasound part of a fetal spine was seen within the right lateral isthmocervical area, adjacent to the descending branch of the uterine artery. Within 4 months after TOP the patient conceived again. This case illustrates the risk of myometrial penetration during mid-trimester TOP by D&E. Removal of intramural bony fragments may not be needed in an asymptomatic patient, as their presence does not seem to compromise fertility.

Abortion, Incomplete↗
PubMed2002

Prenatal findings in a monozygotic twin pregnancy with Costello syndrome.

This report describes the prenatal findings in monozygotic twins with Costello syndrome. At 16 weeks one twin had 9 mm of nuchal oedema: coarctation of the aorta was diagnosed after birth. At 22(5/7) weeks relative macrocephaly, mild pyelectasia and moderate polyhydramnios were noted in both twins. In the following 4 weeks the polyhydramnios increased significantly without visualisation of filling of the stomach. Between 27(5/7) and 30(2/7) weeks a total of 9 l amniotic fluid was drained and at 30(4/7) weeks prelabor premature rupture of membranes (PPROM) occurred followed by premature labor and delivery. The neonatal period was complicated by growth retardation, deglutition problems, hypotonia, cardiac and respiratory problems. Both twins died on Day 57 because of respiratory insufficiency.

Abnormalities, Multiple↗
PubMed2002

Ultrasonographic features of the endometrium and the ovaries in women on etonogestrel implant.

OBJECTIVE: To evaluate the ultrasound features of the endometrium and ovaries in women on etonogestrel implant, and to correlate these features with the bleeding pattern. METHODS: Observational study including 188 consecutive women presenting for follow-up transvaginal ultrasound examination after insertion of an etonogestrel implant contraceptive device. Thirty women had more than one follow-up examination. The bleeding pattern was considered abnormal if, in the last 3 months, there were more than five episodes of vaginal bleeding, or there was prolonged bleeding exceeding 14 consecutive days. RESULTS: At first follow-up examination, the mean age was 29.7 years and 47% of women had an abnormal bleeding pattern. Most bleeding episodes were of less intensity than menses. The mean endometrial thickness (ET) on ultrasound was 2.9 mm (standard deviation, 2.0). Ovarian follicle growth exceeding 5 mm was observed in 60% of the cases. Ovulation was demonstrated in one woman. Univariate analysis showed a positive association (P < 0.01) between ET, bleeding pattern, and bleeding intensity. Follicle growth was positively associated (P < 0.01) with ET, bleeding pattern, and interval between insertion and examination. Multivariate analysis showed that the ET was on average 1.25 mm greater in women with abnormal bleeding (P = 0.0001). The odds of finding follicle growth were 2.8 times higher (95% confidence interval, 1.2-6.2) in women presenting with a three-layer type of endometrial morphology. There was no association between the other patients' characteristics and the bleeding pattern. CONCLUSIONS: Abnormal uterine bleeding in women on etonogestrel implant was associated with follicle growth and a thicker, three-layer type of endometrium, suggesting incomplete ovarian inhibition and estrogen stimulation of the endometrium.

Adolescent↗
PubMed2002

Color Doppler and gray-scale ultrasound evaluation of the postpartum uterus.

OBJECTIVES: To evaluate the color Doppler and gray-scale sonographic appearance of the uterus after pregnancy, with special attention to the occurrence of areas of enhanced vascularity and placental remnants. PATIENTS AND METHODS: Cross-sectional observational study involving 385 consecutive women presenting at their first visit after pregnancy. The uterus was evaluated using ultrasound with color Doppler. In the presence of placental remnants, blood was sampled for measurement of beta human chorionic gonadotropin (beta hCG), hemoglobin (Hb) and infectious parameters. If indicated, a dilatation and curettage was performed. RESULTS: In 8.3% of women, areas of enhanced vascularity were detected with color Doppler examination. Most cases (68.9%) were focal areas of one or more vessels. In 2.6% of patients abnormal vascularity extended over a large area of the whole myometrium. In 6.75% of cases, placental remnants were detected. In 46% of these, blood sampling revealed beta hCG levels below 30 mIU/mL; serological infection parameters and Hb concentration were within the normal range. CONCLUSIONS: Areas of enhanced vascularity of the uterus, ranging from a focal vascular pedicle to a larger area of the myometrium, are relatively common after pregnancy. They are predominantly seen in the presence of placental remnants, in the early postpartum period and after instrumental or manual delivery of the placenta. There are no clear risk factors for retained placental tissue, besides the history of blood transfusion in the early postpartum, and perhaps multigravidity. Serology is of little help in the diagnosis of retained gestational products. The knowledge of the ultrasound and color Doppler features of the uterus after pregnancy may prove of practical value for the management of abnormal uterine bleeding in the postpartum period.

Adolescent↗
PubMed2001

Recent applications of capillary electrochromatography.

A review is presented of the most important recent applications of capillary electrochromatography (CEC) for the analysis of acidic, basic, and neutral compounds, of biomolecules, environmental substances, natural products, pharmaceuticals, and chiral compounds. Packed-column CEC (packed-CEC), open-tubular (OT-CEC), as well as pressure-assisted CEC (pseudo-CEC) are hereby considered. Papers published between July 1999 and April 2001 were taken into account. Applications before July 1999 have been reviewed in Electrophoresis 1999, 20, 3027-3065.

Chromatography, Micellar Electrokinetic Capillary↗
PubMed2000

Vascular malformations in the uterus: ultrasonographic diagnosis and conservative management.

OBJECTIVE: To investigate the presence and outcome of uterine vascular malformations in women with abnormal premenopausal bleeding. STUDY DESIGN: In this observational study 265 consecutive patients with abnormal premenopausal bleeding were examined by the same ultrasonographer with transvaginal gray-scale ultrasonography and color Doppler imaging. A final diagnosis of uterine vascular malformation was based on ultrasonographic findings, hysteroscopy or histological findings. Patients suspected of uterine vascular malformations at ultrasonography were closely monitored. RESULTS: In nine patients (3.4%) we found ultrasonographic features of uterine vascular malformations. Color Doppler imaging showed hypervascularity, marked turbulence, and low-impedance, high-velocity flow. In six patients the condition resolved spontaneously. Two patients with hydatiform mole needed chemotherapy and their condition normalized. One patient underwent a selective embolization of the uterine artery. Subsequently, five patients had uncomplicated pregnancies after resolution of the vascular malformation. CONCLUSION: Uterine vascular malformations are more common than previously thought. We conclude that conservative management is a valuable option in many of the acquired pregnancy-related cases that are diagnosed with color Doppler imaging.

Adolescent↗
PubMed1999

Comparison of highly sulfated alpha-, beta-, and gamma-cyclodextrins and 18-crown-6-tetracarboxylic acid for the enantiomeric separation of some amino acids and derivatives by capillary electrophoresis.

18-Crown-6-tetracarboxylic acid (18C6H4) and highly sulfated cyclodextrins (HS-alpha-, beta-, gamma-CDs) are highly selective chiral selectors for the enantioseparation of solutes bearing the primary amino function. Excellent resolutions were obtained for all solutes on HS-gamma-CD and on 18C6H4. The former, however, is by far the best chiral selector for the solutes studied in this work because the highest resolution is obtained with the shortest migration times. The reversal of the D- and L-migration order on HS-CDs compared to 18C6H4 is an interesting feature for the determination of enantiomeric excess.

Amino Acids↗
PubMed1998

Cervical cytology in menopausal women at high risk for endometrial disease.

The objective of this study was to evaluate the value of cervical cytology in the diagnosis of endometrial disease in women after menopause. In 128 consecutive menopausal women presenting with uterine bleeding (116) or in whom endometrial cells were found on a previous cervical cytology smear (12), an endo- and ectocervical smear was taken before hysteroscopy with curettage. The results of the cervical cytology were compared with the endometrial histology. Mean age was 59 years. The average duration of menopause was 10 years. Endometrial carcinoma was diagnosed by endometrial sampling in six women. In two of these cases cervical smears did not contain endometrial cells. The presence of endometrial cells on ectocervical cytology showed a sensitivity of 67% and a specificity of 78% for endometrial carcinoma vs 80% and 76%, respectively, for endocervical cytology. The positive predictive value for endometrial malignancy of the presence of endometrial cells on cervical cytology ranged between 17% and 13%. The presence of 'atypical' endometrial cells on cervical smear was associated with endometrial malignancy in almost half the cases. Cervical cytology is of limited value in the diagnosis and the management of postmenopausal endometrial disease.

Aged↗
PubMed1996

Endopap-versus Pipelle-sampling in the diagnosis of postmenopausal endometrial disease.

OBJECTIVE: To evaluate the accuracy of Endopap- and Pipelle-sampling in the diagnosis of postmenopausal disease. STUDY DESIGN: Observational study in the setting of a University Hospital. One hundred and six consecutive postmenopausal women presenting with uterine bleeding or endometrial cells on cervical cytology underwent an Endopap sampling as well as a Pipelle biopsy. Thereafter, 89 of those women underwent a hysteroscopy and curettage (n = 71) or a hysterectomy (n = 18). The diagnostic accuracy of Pipelle and Endopap was assessed against the final diagnosis. RESULTS: Endometrial carcinoma was found in five cases (6%), benign disease in 34 (38%). The sensitivity of Endopap and Pipelle for the detection of endometrial disease was 56 and 51%, respectively, with a specificity of 94 and 100%, respectively. The sensitivity for endometrial carcinoma was 80% for Endopap and 100% for Pipelle. CONCLUSIONS: Our data tend to favor Pipelle against Endopap as diagnostic tool in endometrial disease in symptomatic postmenopausal women.

Biopsy↗