[Quality control in breast sonography].
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Biomedical subjects
Publications and source records attributed to V Duda.
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We report an extraordinary case of tumorous type of rhabdomyomatous dysplasia without any other malformation in a fetus of 23 weeks gestation. Histologically, autopsy showed distinctive striated muscle tissue in the upper and middle lobes of the right lung. Unusual in this case, compared with previously published reports, is the absence of further malformations, the occurrence in the apical parts of the lung and the marked degree of rhabdomyomatous dysplasia. The case report is followed by a differential diagnosis, review of the literature and discussion of the pathogenesis.
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Twenty-seven patients with uterine fibroids were treated for 3 months with the GnRH-agonist goserelin prior to surgical myomectomy. Ovarian function was suppressed reliably in all patients. After three applications, 15 fibroids were reduced in volume by more than 50%, and one complete remission was achieved. Seven patients showed a decrease of 10-50% in volume. However, in 5 cases there was no significant reduction. Analysing the time course of the fibroid reduction, the response can be predicted in most cases as early as four weeks after the first injection. Retrospective statistical analysis showed that a 50% reduction in fibroid size due to GnRH treatment is preceded by a 35% reduction after 4 weeks in 81% of cases, and after 8 weeks in all cases. Only 2 of 12 fibroids, which showed a smaller response (less than 50%) to GnRH therapy, were reduced by more than 35% after 4 and 8 weeks. In most cases it seems to be possible to estimate the individual response to GnRH-application after the first injection, so that it is possible to stop therapy in non-responding patients.
To evaluate the risk of abortion after genetic amniocentesis in twin pregnancies, a retrospective study of 15 centers was performed. The spontaneous abortion rate up to 20 completed weeks of gestation was 2.3%; the abortion rate up to 28 completed weeks, as defined by WHO, was 3.7%. The abortion rate could not be correlated either with the number of needle insertions or with the type of marker dye used. There was also no correlation between the abortion rate and the gestational age at which amniocentesis was performed. A significant association was shown between congenital intestinal obstructions and the application of methylene blue intra-amniotically as a marker dye. Considering the increased natural loss rate in multiple gestations, amniocentesis in twin pregnancies seems to be a safe and reliable technique.
The administration of GnRH analogues is expected to improve treatment by avoiding hysterectomy, since problems connected with the surgical removal of leiomyomata are correlated with their size. In this study the GnRH analogue goserelin in its depot formulation (Zoladex, ICI, Plankstadt) was used for treating isolated leiomyomata of the uterus. All patients were treated for 3 months before myomectomy was performed. The complete regression of a large myoma (206 cm3) was observed in 1 of 11 patients. In 5 cases a reduction in volume of more than 50% was achieved. Ovarian function was suppressed by goserelin, after a short-term stimulation, within 7 +/- 3 days. Serum levels of 17 beta-oestradiol were found to be generally less than 25 pg/ml. All patients reported climacteric complaints, but in no case had therapy to be discontinued. After cessation of goserelin, restoration of ovarian function was observed in all patients.
From May to September 1987, 221 women of over 45 years of age were examined by transvaginal ultrasound at the Department of Gynaecology (Gynaecological Hospital) of the University of Marburg. Transvaginal ultrasound proved to be significantly superior to clinical examination, since palpation had resulted in "NAD" findings in all cases. The average diameter and the volume of postmenopausal ovaries, determined by transabdominal sonographic studies, were easily confirmed by the new method. In 6% of the 221 patients, pathological findings of the ovaries were clinically "NAD". Since the usefulness of transabdominal ultrasound in screening for ovarian cancer has already been confirmed by other authors, this pilot study aims at providing an opportunity to test transvaginal ultrasound also in a large ovarian cancer screening programme by furnishing the essential basic research data. Age-adapted average ovarian sizes and significant differences in size between the right and the left ovary were used to differentiate between normal and pathological findings as well as changes in the ovarian parenchymal patterns.
In a 28-year-old patient with a large uterine leiomyoma, complete tumor regression was achieved by the LHRH agonist Zoladex (ICI 118.630) when administered three times. During the follow-up period of three months, new myoma growth did not occur. On the basis of this case study, it is necessary to discuss a new therapy concept for the differentiated treatment of uterine leiomyomata in young women with a desire for pregnancy.
According to the general development in breast diagnosis the positions of the single modalities are described by showing the development of breast diagnosis at the X-ray department of the UFK Marburg. In this context special emphasis is placed on ultrasound mammography and its clinical application at the UFK Marburg during the past 10 years. Automated water coupling and hand held real-time ultrasound are compared with another and the effects of ultrasound mammography on invasive breast diagnostic modalities and on breast surgery are pointed out by means of statistical results.
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The authors report on clinically abnormal palpatory findings in the axilla. The radiology and sonography of these findings is described, as well as differential diagnosis between normal findings and benign as well as malignant changes. If it is not possible to confirm a benign aspect even by means of examination via relevant equipment, histological clarification must be sought whenever there is a new palpatory finding or if changes are noted.
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The article reports on a comparison between 100 x-ray films (preparation radiographies, mammographies) with grid and a film/foil combination on the one hand, and conventional x-ray technique with material testing x-ray film on the other. The clear superiority of grid mammography is demonstrated by means of case examples.
Starting with a survey of the historical development of ultrasound-mammography the current status of this method within other diagnostic procedures of the breast is defined. Basing on over 1000 examinations since 1975 we report the sonographic possibilities in demonstrating different normal and pathologic breast structures. Pathologic structures are: Dudectasy, Cysts, Mastitis, Fibroadenoma, Carcinoma and Gynaecomasty. Own results are reported and the future of ultrasound mammography is discussed.
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Clinical observations on more than 700 patients between September 1979 and October 1980 are reported. If cysts are suspected clinically, ultrasound mammography provides the most reliable diagnosis and is superior to all other methods for localization, fine-needle biopsy and follow-up. Since it is difficult to assess (due to summation effects), the radiologically dense breast (DY) is a further indication for sonography. In case of excentrically located palpatory findings, pregnant or immobile patients, ultrasound mammography can provide valuable diagnostic information.