Francisco Bonilla

Reducing blood loss at myomectomy with use of a gelatin-thrombin matrix hemostatic sealant

OBJECTIVE To evaluate the hemostatic efficacy and handling of gelatin-thrombin matrix in abdominal myomectomy. DESIGN Prospective and randomized trial. SETTING University teaching hospital. PATIENT(S) Women (n = 50) with uterine fibroids with a uterine size equivalent to > or =16 weeks gestation. INTERVENTION(S) Gelatin-thrombin matrix (FloSeal Matrix; Baxter Healthcare Corp., Fremont, CA) was delivered to the site of the uterine bleeding during myomectomy. MAIN OUTCOME MEASURE(S) Patient age, parity, number of myomas, operative time, blood loss, transfusion, intraoperative and postoperative complications, and length of hospitalization were evaluated. RESULT(S) The average blood loss during surgery was 80 +/- 25.5 mL for the FloSeal group and 625 +/- 120.5 mL for the control group. Intraoperative blood transfusion was necessary in five patients from the control group. Postoperative blood loss was 25 +/- 5 mL for the FloSeal group and 250 +/- 75 mL for the control group. Length of the postoperative hospital stay was 2.5 +/- 1.2 days for FloSeal group and 4.5 +/- 1.3 for the control group. No major immediate or delayed complications were observed in either group. CONCLUSION(S) Reductions in hemorrhage in FloSeal-treated women undergoing a myomectomy are encouraging, and provide evidence for the ability of gelatin-thrombin matrix to reduce blood loss when applied immediately and directly to bleeding uterine tissue.

Fetal megacystis: differential diagnosis.

The purpose of our retrospective observational series was to determine whether the sonographic characteristics of fetal megacystic bladders can be used to reliably establish the most likely diagnosis in fetuses with this condition. The sonographic records of pregnant patients referred to our institutions over a 10‐year period who were found on initial 2‐dimensional sonography to be carrying fetuses with megacystis were examined for evidence of a keyhole sign, bladder thickness, amniotic fluid index, and fetal sex. When available, 3‐/4‐dimensional sonography, Doppler angiography, tomographic ultrasound imaging, virtual organ computer‐aided analysis, and automatic volume calculation were used as part of the detailed fetal anatomic survey. Twenty fetuses with megacystis were identified. Seventeen were male; 2 were female; and 1 had ambiguous genitalia. All male fetuses with megacystis originally had a diagnosis of prune belly syndrome. The diagnosis for 10 male fetuses with a keyhole sign was changed to megacystis secondary to posterior urethral valves. The fetus with ambiguous genitalia had prune belly syndrome. One of the female fetuses had a diagnosis of urethral atresia, and the diagnosis for the other female fetus was megacystis‐microcolon‐intestinal hypoperistalsis syndrome. In conclusion, in fetuses with megacystic bladders, it is possible to distinguish between cases with prune belly syndrome, posterior urethral valves, urethral atresia, and megacystis‐microcolon‐intestinal hypoperistalsis syndrome by a detailed anatomic survey using 2‐ and 3‐/4‐dimensioinal sonographic techniques.

Thanatophoric Dysplasia: Ultrasound Diagnosis

Six pregnant women with singleton fetuses were referred to our Prenatal Diagnostic Centers because of an initial diagnosis of intrauterine growth restriction (n = 4) or short femoral length (n = 2). We first examined the patients with two-dimensional (2D) ultrasonography (US), and then with three-dimensional (3D) US, and arrived at a definitive diagnosis of thanatophoric dysplasia. Although in experienced hands a diagnosis of thanatophoric dysplasia can be made with 2D US before the 24th week of gestation, our experience suggests that 3D US is a valuable complement to 2D US for the evaluation of fetuses with skeletal dysplasias.

Endometrial receptivity: evaluation with ultrasound.

Abstract An adequate endometrial receptivity is a crucial factor for embryo implantation. We describe endometrial morphology (endometrial appearance or pattern, endometrial thickness, volume, and delimitation), based on the concepts and possibilities of the new ultrasound modalities (3-dimensional/4-dimensional ultrasound, automatic volume calculation, virtual organ computer-aided analysis, tomographic ultrasound image, inverse mode, and 3-dimensional Doppler angiography) as markers of endometrial receptivity.

HDlive ultrasound images in assisted reproduction treatment

The volume ultrasound technology software known as the HDlive technique represents an innovative tool, a step towards an even more realistic anatomical visualization of pelvic organ structures. HDlive can help improve physician-patient communication with the aid of life-like images and might prove useful in the field of assisted reproduction treatment. The clinical application of this novel ultrasound technology in assisted reproduction treatment deserves scientific evaluation.

Morphological assessment of the umbilical cord with three-dimensional ultrasonography

ABSTRACTThe long cylindrical cord covered by a layer of amnion that extends from the umbilicus of the fetus to the fetal surface of the placenta is known as the umbilical cord, or, in older medical textbooks, as funiculis umbilicalis. The two umbilical arteries extend as branches of the internal iliac arteries that emerge from the fetal body at the umbilicus, and run a helical course through the umbilical cord carrying venous blood to the placenta. In most normal placentas, the umbilical arteries anastomose within 2 cm of insertion into the placenta. The fetal umbilical vein emerges from the placenta and carries oxygenated blood to the fetus. The cord vessels are supported by a matrix of myxomatous connective tissue known as Whartons jelly. The average length of the umbilical cord is approximately 55 cm at term, but extreme variations in length can occur for unknown reasons. The normal umbilical cord is spiralled. On rare occasions, remnants of the omphalomesenteric and allantoic ducts may be found in th...

Three‐dimensional inversion mode rendering in molar pregnancy

C.-P. Chen*†‡§¶, Y.-P. Liu** ††, J.-P. Huang†, T.-Y. Chang†, F.-J. Tsai‡‡, J.-D. Tsai§§¶¶, J.-C. Sheu*** and W. Wang‡ Departments of †Obstetrics and Gynecology, ‡Medical Research, ** Radiology, §§Pediatrics and *** Pediatric Surgery, Mackay Memorial Hospital, ††Mackay Nursing, Medicine and Management College and ¶¶Department of Pediatrics, Taipei Medical University, Taipai and §Department of Biotechnology, Asia University, ¶College of Chinese Medicine, China Medical University and ‡‡Departments of Medical Genetics and Medical Research, China Medical University Hospital, Taichung, Taiwan *Correspondence. (e-mail: cpc mmh@yahoo.com) DOI: 10.1002/uog.5261

Umbilical Cord Cysts Evaluation With Different 3-Dimensional Sonographic Modes

Objective. The purpose of this series was to determine whether the use of different 3‐dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2‐dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer‐aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three‐dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. Conclusions. Three‐dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.

Multimodality 3-dimensional volumetric ultrasound in obstetrics and gynecology with an emphasis in HDlive technique.

HDlive (high-definition live or real-time US), a new ultrasound software, combines a movable virtual adjustable light source in a software that calculates the proportion of light reflecting through surface structures, depending on light direction. The light source can be manually positioned to illuminate the desired area of interest. The ultrasound technician can control light intensity to create shadows that enhance image quality. HDlive is an innovation that will render even more realistic images of fetal anatomy and of gynecologic lesions. The full potential of this new technology is yet to be determined and deserves scientific evaluation.

Útero septo con duplicación cervical: una anomalía mülleriana infrecuente

Resumen En el presente caso hemos descrito una variante mulleriana infrecuente (utero septo y cervix doble), que resulta inconsistente con la embriologia clasica. Asimismo, hemos realizado un diagnostico correcto mediante el empleo de ecografia tridimensional, que representa el primer caso de la bibliografia mundial descrito mediante esta tecnica ecografica. Por ultimo, hemos repasado las opciones terapeuticas y discutido su inclusion futura en la clasificacion de las malformaciones uterinas