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Intraoperative transthoracic ultrasonographic localization of occult lung lesions

During video-assisted thoracoscopic operations, identification of small peripheral lung nodules can be challenging. We report the use of intraoperative intrathoracic ultrasonography for localization of lung tumors before resection in 2 patients.

Transvaginal intratubal methotrexate treatment of ectopic pregnancy

OBJECTIVEnTo evaluate the efficacy of transvaginal intratubal methotrexate (MTX) treatment of tubal ectopic pregnancy (EP).nnnSETTINGnOutpatient setting in University Hospital.nnnPATIENTSnForty women with early EP and rising serum beta-human chorionic gonadotropin (beta-hCG) levels.nnnINTERVENTIONnTransvaginal intratubal administration of MTX (1 mg/kg body weight).nnnMAIN OUTCOME MEASURESnSuccess was defined as declining serum beta-hCG to undetectable levels, no tubal dilatation on ultrasound examination, and no further intervention was required.nnnRESULTSnTreatment was associated with a 70% success rate. No difference was found in the success rate between women with an embryo (76.9%) and those with no embryo in their fallopian tubes (66.7%). The initial serum beta-hCG levels were also not different between patients who were successfully treated and those who failed to respond to the treatment. Despite declining serum beta-hCG levels, tubal rupture occurred in two patients.nnnCONCLUSIONSnTreatment of EP by transvaginal MTX administration is associated with a 70% success rate. This is independent of the presence of an embryo or the initial serum beta-hCG levels. Rupture of EP can still occur despite low and declining serum beta-hCG levels.

Accuracy of endovaginal sonography for the detection of fallopian tube blockage.

The patency of 814 fallopian tubes in 414 patients was evaluated by endovaginal sonography immediately prior to hysterosalpingography. In the 659 fallopian tubes that were normal with free spillage, endovaginal sonography did not reveal any tubal or peritubal abnormality (specificity 100%). Of the 64 fallopian tubes with definite hydrosalpinx on hysterosalpingography, only 22 were detected on endovaginal sonography (sensitivity 34%). Four of 57 (7%) fallopian tubes with definite proximal blockage on the hysterosalpingogram showed hydrosalpinx on the same side on endovaginal sonography, indicating the association of proximal and distal tubal blockages in a small group of patients with blocked fallopian tubes. This combination can only be detected by the addition of endovaginal sonography to hysterosalpingography. Ten of 11 (91%) hydrosalpinges in seven patients who underwent endovaginal sonography immediately after hysterosalpingography were detected by ultrasonography. Only two of these had been visible on pre‐hysterosalpingography endovaginal sonograms. This would indicate that the poor sensitivity of endovaginal sonography for diagnosing hydrosalpinx is at least partly due to its lack of distention. We conclude that an abnormal endovaginal sonogram is highly predictive of the presence of a blocked tube, but endovaginal sonography has a poor sensitivity for the diagnosis of a hydrosalpinx detectable by hysterosalpingography. Endovaginal sonography would be useful to detect a combination of proximal and distal blockage in a subgroup of patients with tubal blockage.

Streamlined flow in the portal vein: Demonstration with MR angiography

To demonstrate whether streamlining of the portal vein flow exists by evaluating the relative distribution of blood flowing from the superior mesenteric vein (SMV) and splenic vein (SV) into the portal venous system.

Comparison of qualitative and quantitative measurements on unenhanced T1‐weighted fat saturation MR images in predicting pancreatic pathology

To evaluate the accuracy of signal intensity (SI) analysis on unenhanced fat‐suppressed T1‐weighted MR images in the diagnosis of pancreatic disease and to compare subjective interpretation with different quantitative measurements.

Implementation of a filmless mini picture archiving and communication system in ultrasonography: Experience after one year of use

This article details our experience in developing and operating an ultrasound mini-picture archiving and communication system (PACS). Using software developed in-house, low-end MacIntosh computers (Apple Computer Co, Cupertino, CA) equipped with framegrabbers coordinate the entry of patient demographic information, image acquisition, and viewing on each ultrasound scanner. After each exam, the data are transmitted to a central archive server where they can be accessed from anywhere on the network. The archive server also provides web-based access to the data and manages pre-fetch and other requests for data that may no longer be on-line. Archival is fully automatic and is performed on recordable compact disk (CD) without compression. The system has been filmless now for over 18 months. In the meantime, one film processor has been eliminated and the position of one film clerk has been reallocated. Previously, nine ultrasound machines produced approximately 150 sheets of laser film per day (at 14 images per sheet). The same quantity of data are now archived without compression onto a single CD. Start-up costs were recovered within six months, and the project has been extended to include computed tomography (CT) and magnetic resonance imaging (MRI).