Faculty Bibliography

Previously endovaginal ultrasonography was considered an adjunct for use in full-service ultrasound facilities by subspecialists only. The technique, however, has tremendous application for use by the clinician in the examination room for patients at bimanual examination. This is because the procedure is meant to be performed with an empty urinary bladder. It requires very little time once the operator is adequately trained. It provides excellent resolution despite high degrees of magnification. This allows for a distinction between a traditional ultrasound examination and this new concept of examining gynecologic patients with vaginal probe ultrasonography as a part of the routine overall gynecologic examination. Methodology and philosophic issues arising from such a concept are discussed.

Often ovarian cancer does not present clinically until the advanced stages. In the past, the presence of any cystic adnexal enlargement in postmenopausal women was an indication for surgical exploration. The ultrasound scans of 42 postmenopausal women with simple adnexal cysts were reviewed. We included only patients who were available for follow-up and who had cysts that were less than or equal to 5 cm in maximum diameter, unilocular (ie, without septations or solid components), and without ascites. Of these patients, 26 underwent prompt surgical exploration. All exhibited benign histopathology. In 16 patients, serial sonographic surveillance was performed every 3-6 months. Two of these patients had exploratory laparotomy at 6 and 9 months of observation; the first operation, for increasing size and septation, demonstrated a cystadenofibroma, and the second, for increasing pain, demonstrated a degenerating myoma. The remaining 14 patients were followed from 10-73 months without any change in size or character of the cyst. Small (less than 5 cm), unilocular postmenopausal cysts had a low incidence of malignant disease (0%) in this series of 28 surgical specimens. Therefore, serial ultrasound follow-up without surgical intervention may play a role in the clinical management of such patients

There are many situations in which the earliest possible detection of an intrauterine pregnancy would enhance clinical management. Current radioimmunoassays for hCG can detect pregnancy as early as eight to 12 days post-conception. The ability to document an intrauterine pregnancy with ultrasound has lagged behind by two to three weeks. New high-frequency endovaginal transducers offer the promise of narrowing this gap. This study was undertaken prospectively on 235 patients all amenorrheic for seven weeks or less and requesting either pregnancy testing or termination. All had endovaginal ultrasound scans. We obtained hCG levels when no sac was seen or when the sac was less than 1.0 cm (initial experience revealed that all sacs over 1.0 cm were associated with hCG levels over 6000 mIU/mL) (International Reference Preparation). Ultrasound findings were correlated with pathology specimens and/or hCG levels where appropriate. Results indicated that normal pregnancies can be imaged when: 1) The sac is greater than 0.4 cm; 2) hCG is greater than 1025 mIU/mL (International Reference Preparation); and 3) the uterus is normal with a homogeneous echo pattern. This was not true in three of our cases with diffuse myomatous changes or a coexisting intrauterine device

To facilitate accurate and standard methods of reporting pathologic uterine corpus enlargement, we constructed a nomogram using the gravid uterine corpus volumes from five to 20 weeks' gestation in 186 patients. The volume was calculated by measuring the maximum length and anteroposterior and transverse diameters of the uterine corpus, and using the formula for the volume of a prolate ellipsoid: V = 0.52 X (L X AP X T). Clinicians can use the nomogram for better understanding in assessing uterine volume

In this study, we attempted to develop a surveillance protocol for elective first-trimester termination to see whether unsuspected ectopic pregnancy could be detected earlier, and to identify those patients with unsuspected second-trimester pregnancies that could be terminated more safely in the hospital. Two hundred fifty consecutive patients requesting elective termination were studied prospectively. All were 12 weeks or less by last menstrual period, had positive urinary pregnancy tests, and had no history of vaginal bleeding. All patients had ultrasound screening before curettage. Immediately after curettage, a 'modified' gross pathologic examination (3X magnification) was also performed on unstained curettage material. The sonographic, operative, and pathologic findings were all correlated. Such screening identified four patients with unruptured ectopic pregnancies, who were operated on the same day as the curettage. In addition, four patients, who were actually in the second trimester but had inaccurate dates, were identified and referred to hospital for appropriate methods of termination. We conclude that such surveillance may reduce morbidity in elective terminations and more rapidly identify unsuspected ectopic pregnancies

The sine qua non of fetal well-being in the first trimester is considered to be the presence of fetal cardiac activity. Despite fetal viability, some pregnancies might have a sac that is too large or small for the gestational age, even in the first trimester. As a first step in evaluating this hypothesis, a nomogram was constructed for the ratio of normal sac volume to crown-rump length

Phosphorus-31 nuclear magnetic resonance spectroscopy (31P NMR) was used to assess the temporal changes of high-energy phosphate metabolites in the region of acute myocardial ischemia of open-chest cats. Eight anesthetized cats were studied following ligation of the left anterior descending coronary artery. Creatine phosphate showed a 79 +/- 16% (mean +/- SD) reduction by 4 min after the onset of ischemia. Prominent qualitative reductions of the spectral peak of creatine phosphate occurred by 40 s after ischemia. Adenosine triphosphate measured under the beta spectral peak (beta-ATP) decreased 37 +/- 9% by 20-25 min after ligation of the left anterior descending coronary artery. These reductions developed more slowly and were of smaller magnitude than those of creatine phosphate. Intracellular pH decreased from 7.39 +/- 0.07 to 7.13 +/- 0.09 units by 40 s after ischemia. By 30 min, pH decreased to 6.07 +/- 0.40 units. The study shows, therefore, the temporal changes of high-energy phosphate metabolites during ischemia in localized regions of the myocardium of open-chest animals