Luciano Bovicelli

Cerebellar measurements with ultrasonography in the evaluation of fetal growth and development

A prospective study of ultrasonography was conducted in 371 normal pregnant women, with gestational ages ranging from 13 weeks to 40 weeks. Several biometric measurements were obtained including the transverse cerebellar diameter, the biparietal diameter, the occipitofrontal diameter, and the calculated head circumference. Curvilinear relationships were found between the transverse diameter of the cerebellum (measured in millimeters), and the gestational age (R2 = 0.948; P = 0.001), the biparietal diameter (R2 = 0.956; P = 0.0001), and the head circumference (R2 = 0.969; P = 0.0001). A nomogram of cerebellar measurements estimating gestational age and predicting the biparietal diameter and head circumference was generated. Throughout pregnancy the establishment of normative cerebellar measurements allows for the estimation of gestational age that is independent of the shape of the fetal head and offers potential for evaluation of abnormal fetal growth and anomalous development of the central nervous system.

Ultrasonic findings in polycystic ovarian disease

The uterus and ovaries of 50 patients with polycystic ovarian disease (PCOD) and 30 eumenorrheic women were studied with a real-time ultrasound mechanical sector scanner. Uterine and ovarian volumes (UV and OV) and the OV/UV ratio were calculated, and ovarian morphology was classified as prevalently solid and cystic. Both ovaries were displayed in 44 of the PCOD and in 25 of the normal patients and appeared bilaterally solid, cystic, or with different morphology, respectively, in 43.2%, 47.7%, and 9.1% of cases in the former group and in 76%, 20%, and 4% in the latter group. Statistically significant differences between normal and PCOD patients were found in OV, UV, and OV/UV ratio. Bilaterally enlarged ovaries with multiple tiny cysts, the classic ultrasonographic picture of the polycystic ovary, were found in only 16 (36.3%) of the PCOD cases, while 34 (77.3%) had an OV/UV ratio greater than 1 standard deviation above the mean. Four ultrasonographic ovarian patterns were observed in the PCOD patients: enlarged cystic; enlarged solid; normal-sized cystic; and normal-sized solid. These findings emphasize the need for a reconsideration of the ultrasonographic criteria of PCOD.

Outcome of antenatally diagnosed intracranial hemorrhage: case series and review of the literature

Prenatal diagnosis of intracranial hemorrhage (ICH) has been widely reported. Hemorrhages may occur either within the cerebral ventricles, subdural space or infratentorial fossa. The aim of this study was to determine the sonographic criteria for the diagnosis of fetal ICH, the role of in utero magnetic resonance imaging (MRI) and the outcome of this condition.

A novel hyaluronan-based gel in laparoscopic adhesion prevention: preclinical evaluation in an animal model

OBJECTIVE To evaluate the effectiveness of a crosslinked hyaluronan solution (ACP gel) in the prevention of postsurgical adhesions in laparoscopic surgery. DESIGN A randomized blinded study using a rabbit model in laparoscopic surgery. SETTING A standardized surgical trauma in the rabbit uterine horn to induce adhesion formation. ANIMALS Sixty-four sexually matured female New Zealand white rabbits weighing 2.5 to 3.0 kg and aged 3-4 months. INTERVENTION(S) After trauma, group 1 (n = 22) received no treatment, group 2 animals (n = 20) received oxidized-regenerated cellulose (Interceed [TC7]) in group 3 (n = 22) 5 mL of ACP gel were applied on the lesion. MAIN OUTCOME MEASURE(S) Six weeks after laparoscopy, a laparotomy was performed and the adhesions were scored according to Blauers scoring system. RESULT(S) 66% of the untreated animals and 85% of the animals treated with Interceed presented with severe adhesions, whereas only 35% of the ACP gel treatment group had significant adhesions. The mean ( +/- SEM) increased adhesion score was 2.24 +/- 0.26 in the untreated group, 2.45 +/- 0.22 in the Interceed group, and was 1.25 +/- 0.28 in the ACP gel group. CONCLUSION(S) This study revealed that ACP gel holds promise as a novel resorbable biomaterial for the reduction of postoperative adhesions after laparoscopic surgery.

Acceptability and Pain of Outpatient Hysteroscopy

STUDY OBJECTIVE To investigate the pain and acceptability of diagnostic hysteroscopy performed without local anesthesia. DESIGN Prospective, observational study (Canadian Task Force classification II-2). SETTING University-associated department of obstetrics and gynecology. PATIENTS The 1144 consecutive women who underwent diagnostic hysteroscopy. INTERVENTIONS Diagnostic hysteroscopy and endometrial biopsy as indicated. MEASUREMENTS AND MAIN RESULTS Patients were asked to rate the pain experienced on a 10-cm visual analog scale and to state if they were willing to repeat the procedure. The mean pain score was 4.7 +/- 2.5; 398 patients (34.8%) experienced severe pain. No risk factors for painful hysteroscopy were found, although abnormality of the cervical canal was associated with high pain scores. Acceptance of the procedure was high, 83.0% (950 women). CONCLUSION Diagnostic hysteroscopy is a painful procedure even when performed with atraumatic technique by experienced surgeons. Most women, however, stated they were willing to have a second procedure under the same conditions.

Prenatal diagnosis of craniofacial malformations with ultrasonography.

Although the utility of ultrasound in the prenatal diagnosis of many congenital anomalies is well established, its accuracy in detecting craniofacial malformations has not been examined in a large series. Sonographic examinations of 223 patients at risk for fetuses with craniofacial malformations were performed between 18 and 40 weeks. The risk factors included a familial history of craniofacial malformations, extrafacial anomalies diagnosed on ultrasound, fetal chromosomal aberrations, and maternal drug intake. Sonographic diagnosis was possible in 151 (67.7%) patients on the first scan and in 47 (21.1%) patients on the second scan and was not possible in 25 patients (11.2%). Of the 198 cases diagnosed antenatally, craniofacial malformation was detected in 14 and confirmed postnatally. No false positive diagnoses were made. A negative diagnosis of craniofacial malformation was made in 184 cases with two false negative results (1.0%). Anomalies diagnosed sonographically included anophthalmia, anterior cleft lip and/or palate, hypotelorism, hypertelorism, and micrognathia. The results of this study demonstrate that ultrasound is an accurate and reliable tool for the prenatal diagnosis of craniofacial malformations.

Pelvic ultrasonography in girls with precocious puberty, congenital adrenal hyperplasia, obsesity, or hirsutism

Real-time ultrasonography of the pelvic organs was performed on 151 girls with various complete and incomplete forms of precocious puberty, 20 girls with congenital adrenal hyperplasia, 20 with hirsutism, 18 with obesity, and 133 age-matched normal girls. Uterine and ovarian volumes were calculated and the ovarian morphologic picture was classified as homogeneous, nonhomogeneous (less than three small cystic areas), microcystic (four or more small cystic areas less than 9 mm in diameter), follicular (at least one cystic area greater than 9 mm), and macrocystic (large cystic area greater than 20 mm). Ultrasound imaging allowed an easy distinction between true precocious puberty and premature thelarche or idiopathic premature adrenarche. It was also helpful in the diagnosis of transient sexual precocity, although in these cases the differential diagnosis of precocious puberty can be difficult. In postmenarcheal patients with congenital adrenal hyperplasia, ultrasound study showed a low uterine volume and, frequently, a macrocyst in the ovary. In hirsute girls and in a few obese patients, ovaries had an increased volume and a microcystic structure, similar to those in polycystic ovary syndrome. Pelvic ultrasonography can be useful not only in diagnosing disorders in sexual development but also for greater understanding of the pathogenesis of these and other disorders.

The clinical significance of prenatally diagnosed choroid plexus cysts

The choroid plexus cyst is one of many malformations of the central nervous system that can be detected in utero by ultrasonography. Choroid plexus cysts occur in 2.3% of fetuses. Because previous reports have shown an association between choroid plexus cysts and chromosomal anomalies, we analyzed 82 prenatally diagnosed cases, 65 of whom had chromosome analysis performed. Of the group, 6.2% had chromosomal anomalies of the trisomy 18 type. The remaining 17 cases were clinically normal at birth. These cases of trisomy 18 were also associated with multiple structural anomalies. Therefore, we suggest that after the diagnosis of choroid plexus cysts is made, a complete ultrasonographic survey of the fetal anatomy be performed. Fetal karyotype determination may be offered to patients, especially in the presence of structural anomalies.

Vaginal cuff dehiscence after hysterectomy: a multicenter retrospective study

OBJECTIVE This study estimates the incidence of vaginal cuff dehiscence resulting from different approaches to hysterectomy. STUDY DESIGN This multicentric study was carried out retrospectively. We retrospectively analyzed 8635 patients; 37% underwent abdominal hysterectomy, 31.2% vaginal hysterectomy, and 31.8% laparoscopic hysterectomy. All the hysterectomies were considered, vaginal evisceration was registered and analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. Continuous variables were compared using the one-way analysis of variance between groups as all data followed a Gaussian distribution, as confirmed by the Kolmogorov-Smirnov test. Differences among subgroups were assessed using the Tukey-Kramer multiple comparisons test. Categorical variables were compared with two tailed Chi-square tests with Yates correction or Fishers exact test, as appropriate. Pearsons linear correlation was used to verify linear relationships between the dehiscence interval and patients age at surgery. RESULTS Thirty-four patients (0.39%) experienced vaginal evisceration. The laparoscopic route was associated with a significantly higher incidence of dehiscence (p<0.05). No differences were found between the 6027 patients (69.8%) who had closure of the vaginal cuff and the 2608 (30.2%) who had an unclosed cuff closure technique. CONCLUSION Vaginal evisceration after hysterectomy is a rare gynecological surgical complication. Sexual intercourse before the complete healing of the vaginal cuff is the main trigger event in young patients, while evisceration presents as a spontaneous event in elderly patients. Surgical repair can be performed either vaginally or laparoscopically with similar outcomes.

Psychological Reactions to Ultrasound

Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.