Benjamin Caspi

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women

OBJECTIVEnTo evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women.nnnDESIGNnA prospective study.nnnSETTINGnTertiary hospital-based ultrasonographic unit.nnnPATIENT(S)nBetween 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel.nnnINTERVENTION(S)nUltrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered.nnnMAIN OUTCOME MEASURE(S)nProspective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up.nnnRESULT(S)nFor the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases.nnnCONCLUSION(S)nPremenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

The contribution of transvaginal ultrasound in the diagnosis of acute appendicitis: an observational study

To assess the contribution of transvaginal and transabdominal sonography in the diagnosis of acute appendicitis.

Sonographically guided aspiration of ovarian cyst with simple appearance.

The objective of this study was to evaluate the role of sonographically guided aspiration of simple ovarian cysts. During the period from 1985 through 1992, 107 ultrasonographically guided punctures of apparently simple ovarian cysts were performed. The group included 76 premenopausal and 31 postmenopausal women who were followed for 1 to 6 years (mean, 2.7 years) after initial cyst puncture. In 42 cases, cyst aspiration constituted the definitive therapy. In 65 cases the cyst recurred and in this group, 38 women (with complete recurrence) were operated on whereas 27 women with a cyst less than 5 cm (incomplete recurrence) were allocated to a follow‐up group. Overall, in 69 cases (65%) surgery was avoided. No major complications were encountered. In our experience, aspiration of simple ovarian cysts is a suitable alternative in the management of this problem. Close follow‐up is necessary to detect recurrence and perform surgical intervention when indicated.

Chorionic villus sampling in multiple pregnancies.

Prenatal genetic diagnosis is recommended in multiple pregnancies because of the increased prevalence of genetic abnormalities in such fetuses. It can be done early by chorionic villus sampling or later by amniocentesis. Several studies have demonstrated the efficacy and safety of chorionic villus sampling in multiple pregnancies. Our study describes the results of this method in a twin pregnancy and in 3 triplet pregnancies, which represent 3% of the chorionic villus samplings performed in our ultrasound unit during 1989-95. All genetically deformed fetuses in these pregnancies were identified by chorionic villus sampling and the method was not associated with fetal loss. Our results confirm the safety and efficacy of chorionic villus sampling as expressed in the world literature.

Sonographic detection of vaginal foreign bodies.

Vaginal foreign bodies should be suspected in children who have recurrent or persistent discharge, bleeding, or both. I To detect the foreign object, an examination of the vagina, usually under anesthesia, is necessary. Despite the fact that ultrasonographers are cognizant of the potential usefulness of ultrasonography for detecting intravaginal foreign bodies in children, and intuitively know what to anticipate seeing, there has been surprisingly little published about it. In 1978 Gates illustrated an example of such a case. 1 We present the cases of two girls with vaginal foreign bodies, emphasizing the sonographic appearance of the objects in these cases.

Variable Echogenicity as a Sonographic Sign in the Preoperative Diagnosis of Ovarian Mucinous Tumors

Objective. The purpose of this study was to evaluate the reliability of the “variable echogenicity” sign in the preoperative sonographic diagnosis of ovarian mucinous tumors. Methods. Variable echogenicity was detected sonographically in different compartments of 8 adnexal multilocular masses. This finding was correlated with the final histologic results. Results. All 8 tumors were mucinous cyst adenomas. In 3 of them, borderline malignancy was present. Conclusions. The sonographic detection of variable echogenicity in the contents of an adnexal multilocular cyst strongly suggests a mucinous tumor.

Alcohol sclerotherapy for successful treatment of focal adenomyosis: a case report.

Adenomyosis is characterized by the presence of ectopic endometrial tissue within the myometrium. Treatment options range from use of non‐steroidal anti‐inflammatory drugs and hormonal suppression for symptomatic relief, to endometrial ablation or even hysterectomy. We report a case of successful ultrasound‐guided aspiration of focal adenomyosis with intracavitary alcohol instillation in a patient with a recurrent intramural uterine lesion. This is the first report of the treatment of sclerotherapy by alcohol instillation, which may be considered as a reasonable alternative modality in treating rare cases of symptomatic adenomyosis. Copyright

“Onion skin” sign in an ovarian mucinous cyst

The sonographic “onion skin” sign was initially described as concentric echogenic layers in mucinous tumors unrelated to the female reproductive system. Typically, the sonographic appearance of ovarian mucinous cystadenoma includes numerous septa and fine, gravity‐dependent echoes. We present a case of the “onion skin” sign in a mucinous ovarian tumor.