I. Meizner

Predictive value of transvaginal sonography performed before routine diagnostic hysteroscopy for evaluation of infertility

OBJECTIVE To compare transvaginal sonography with hysteroscopy for the evaluation of intrauterine disorders. DESIGN Clinical study. SETTING Academic research environment. PATIENT(S) Patients who were undergoing initial evaluation for primary or secondary infertility or investigation after three failed IVF attempts. INTERVENTION(S) Transvaginal sonography was performed, followed by hysteroscopy, between January 1998 and April 1999. The endometrial findings at sonography were compared with those at hysteroscopy, which served as the gold standard. The characteristic sonographic features of intrauterine adhesions were defined. MAIN OUTCOME MEASURE(S) Intrauterine adhesions, endometrial polyps. RESULT(S) The sensitivity, specificity, and positive and negative predictive values for transvaginal sonography in detecting abnormal uterine cavities were 100%, 96.3%, 91.3%, and 100%, respectively. The corresponding values for the specific diagnoses of intrauterine adhesions and endometrial polyps were 80%, 100%, 100%, and 97%, and 71.4%, 100%, 100%, and 97.1%, respectively. On transvaginal sonography, intrauterine adhesions appeared as hyperechoic endometrial foci and were differentiated from endometrial polyps by their irregular shape and more precise localization. The performance of transvaginal sonography at midcycle (three-layer endometrium) rather than after menstrual cessation (endometrial thickness <3 mm) enabled better imaging of small intrauterine adhesions. CONCLUSION(S) A regular myometrial-endometrial interface and homogeneous endometrial structure on transvaginal sonography congruent with the phase of the menstrual cycle indicated a normal endometrium and precluded the need for diagnostic hysteroscopy. Transvaginal sonography may be used as the initial diagnostic procedure to select patients for hysteroscopy.

Risk factors for cardiac malformations detected by fetal echocardiography in a tertiary center

OBJECTIVE Fetal echocardiography accurately detects congenital cardiac anomalies, but it is costly, time-consuming, and requires highly-skilled operators. Our aim was to define those patients for whom fetal echocardiography is justified. METHODS The files of 1696 consecutive patients who underwent second- to third-trimester fetal echocardiography at our tertiary center between 1997 and 1999 were reviewed for reason for referral, echocardiography diagnosis, and pregnancy outcome. RESULTS The patients were categorized by reason for referral into high-and low-risk groups. The high-risk group included 662 patients (39%) with fetal risk factors, 178 (10.5%) with maternal risk factors and 279 (16.5%) with poor obstetric history. The remaining 577 women (34%) were considered low-risk population. These included 282 self-referred women (due to maternal anxiety) who served as control group, 78 women who were referred because of a suspected cardiac malformation on routine second-trimester ultrasound, and 213 women who were referred because of failure to view the heart on second-trimester ultrasound. In 46 women, cardiac anomalies (2.7%) were detected prenatally and confirmed postnatally; most of them (41/46, 89%) were in the low-risk population. Abnormal cardiac findings on second-trimester ultrasound and a diagnosis of a single umbilical artery made the most significant contribution to the detection of cardiac abnormalities (p < 0.001 and p = 0.02, respectively). CONCLUSIONS Most fetal cardiac malformations occur in the low-risk population. Abnormal view of the fetal heart on routine second-trimester screening is highly predictive of congenital cardiac anomalies.

Chemotherapy-Induced Ovarian Failure as a Prototype for Acute Vascular Toxicity

BACKGROUND Chemotherapy-related amenorrhea is a frequent side effect observed in young breast cancer patients. Studies in mice revealed that chemotherapy-induced gonadal toxicity may result from vascular damage. We prospectively evaluated ovarian blood flow and function in young breast cancer patients following chemotherapy. METHODS Young female patients with localized breast cancer undergoing adjuvant or neoadjuvant anthracycline- or taxane-based chemotherapy were evaluated using transvaginal ultrasound prior to initiation of and immediately after cessation of chemotherapy. Doppler-flow velocity indices of the ovarian vasculature-resistance index (RI), pulsatility index (PI)-and size measurements were visualized. Hormonal profiles, anti-Müllerian hormone (AMH) levels, and menopausal symptoms were assessed at the same time points. RESULTS Twenty breast cancer patients were enrolled in the study. The median age was 34 ± 5.24 years. Ovarian blood flow was significantly reduced shortly following chemotherapy: RI decreased by 52.5% and PI decreased by 24.2%. The mean ovarian size declined by 19.08%. Patients who were treated with sequential chemotherapy experienced further reductions in ovarian blood flow and ovarian size after the second sequence. AMH levels dropped dramatically in all patients following treatment. Hormonal profiles after treatment depicted a postmenopausal profile for most patients, accompanied by related symptoms. CONCLUSIONS Our results may imply a mechanism of chemotherapy-induced ovarian toxicity manifested by decreased ovarian blood flow accompanied by a reduction in ovarian size and diminished post-treatment AMH levels. Based upon our former preclinical studies, we assume that this may derive from an acute insult to the ovarian vasculature and may represent an initial event triggering a generalized phenomenon of end-organ toxicity.

Prenatal sonographic predictors of postnatal pyeloplasty in fetuses with isolated hydronephrosis

To define prenatal sonographic predictors of ureteropelvic junction obstruction requiring postnatal pyeloplasty, in fetuses with isolated hydronephrosis.

Sonographic evaluation of kidney parenchymal growth in the fetus

ObjectiveThe aim of the study was to establish a nomogram for renal parenchymal thickness throughout pregnancy.MethodsOne-hundred and twenty-eight healthy women with singleton, well-dated, uncomplicated second- or third-trimester pregnancies were prospectively evaluated for renal parenchymal thickness on routine ultrasound scans. The renal parenchyma was measured in transverse and sagittal sections using predefined criteria.ResultsThere were no differences in anterior or posterior parenchymal measurements in either plane by fetal sex. On sagittal-section analysis, no differences were noted between the right and left kidneys. A nomogram was established on the basis of the findings. The results showed constant linear growth of the fetal parenchyma during pregnancy.ConclusionsThe normal fetal parenchyma grows at a constant, linear rate throughout pregnancy. The nomogram formulated may serve as a basis of future studies of the correlation of parenchymal thickness with postnatal kidney function in fetuses with urinary tract anomalies.

Reference values for fetal penile length and width from 22 to 36 gestational weeks

Current reference range values for fetal penile growth are based on length measurements. However, methodologies for measuring penile length differ among studies and from the standard technique used in children. We propose that the measurement of penile width may aid in its evaluation. The aim of the study was to create normograms for penile length and width.

Predictive value of cervical length in women with twin pregnancy presenting with threatened preterm labor

To assess the accuracy and determine the optimal threshold of sonographic cervical length (CL) for the prediction of preterm delivery (PTD) in women with twin pregnancies presenting with threatened preterm labor (PTL).

Association of fetal biparietal diameter with mode of delivery and perinatal outcome.

To determine the association between sonographic assessment of fetal biparietal diameter (BPD) and pregnancy outcome.

Is measurement of cervical length an accurate predictive tool in women with a history of preterm delivery who present with threatened preterm labor

To determine whether sonographically measured cervical length is an effective predictive tool in women with threatened preterm labor and a history of past spontaneous preterm delivery.

Comment on “In utero gratification behavior in male fetus”

I read with interest the research letter entitled: ‘In utero gratification behavior in male fetus’ by Rodríguez Fernández and López Ramón y Cajal. Looking at Figure 1 presented in the letter, one would have to conclude that the authors have made one huge error in the interpretation of the pictures presented. Picture no. 1 in Figure 1 represents a grasped normal hand with five fingers. What the authors mark as foreskin is the normal index finger. In picture no. 2 in Figure 1, one can see the flexed hand with five fingers. What the authors mark as meatus is the flexed index finger, a bit drawn backwards. The normal penis and scrotum are clearly visible in this picture, appearing medially to the clenched hand. I have indicated real penile tip and scrotum on a photocopy of picture 2, enclosed herewith. The penis and scrotum are clearly visible also in pictures 3 and 4, where the glans and foreskin indicated in these pictures really represent the index finger. There is neither meatus nor foreskin present in Figure 1. The real scrotum and penis are just in front of our eyes with an adjacent to normal clenched hand. I would recommend turning the three-dimensional image 90° clockwise, thus enabling full visualization of the fetal genitalia. This is easy to perform, because the authors state that they have the four-dimensional rendering.