Paul A. Dubbins

Ultrasound criteria in the diagnosis of polycystic ovary syndrome (PCOS)

Not all women with the polycystic ovary syndrome (PCOS) on ultrasound (US) will have the syndrome, and clinical and biochemical features of PCOS may be present without US features. The sensitivity of US in detecting PCOS was, therefore, prospectively determined in 72 women (32 PCOS and 40 controls). The most sensitive features were the presence of 10 or more follicles (82% and 69% in the left and right ovary) and a peripheral distribution of follicles (81.8% and 71.9% in the left and right ovary). Although ovarian enlargement and stromal brightness were not as sensitive as the previous criteria, stromal brightness was most specific. Combining all the criteria predicted a diagnosis of PCOS or control correctly in 86.4% of cases. This study shows that established US criteria of polycystic ovaries remain of value in the diagnosis of PCOS; however, the discrepancy between the left and right ovaries is an interesting but unexplained finding.

Role of Simulation-Based Education in Ultrasound Practice Training

The aim of this systematic review was to determine whether ultrasound (US)/US procedural simulation leads to improvement in US competence, particularly in the clinical setting. The electronic databases MEDLINE, EMBASE, CINAHL, ERIC, and OVID were searched for relevant published articles between 1950 and April 2011. Fourteen articles of an initial 371 articles met the inclusion criteria. The eligible studies differed in terms of the study population, sample size, study design, US simulator used, and measured outcomes. Most of the studies demonstrated acquisition of knowledge and skills with suggestions of correlation with simulation training and improved performance in the same simulated environment. There is little compelling evidence based on published studies at present to support the widespread adoption of simulation‐based medical education to improve clinical US competence.

Real-time ultrasonographic evaluation of normal fetal adrenal glands.

Using real‐time ultrasonography, the normal fetal adrenal glands can be consistently imaged after 30 weeks of gestational life. It was found that the normal fetal adrenals had specific size, shape, and echogenicity and could be consistently separated from the adjacent kidneys. The long axis of the adrenal gland had a range of 14 to 22 mm, compared with a range of renal lengths of 27 to 42 mm, with a ratio of the long axes of fetal adrenal to fetal kidney of .48 to .66. These figures compare favorably with dimensions of the adrenals and kidneys found in newborn autopsies. Since certain in utero abnormalities change the size and shape of normal fetal adrenal glands, these data should serve as a reference to evaluate adrenal disturbances. In addition, it would be expected that failure to image either the kidney or adrenal gland after 30 weeks would strongly imply abnormality in that gland.

Sonographic demonstration of a pharyngoesophageal diverticulum

We report a case of pharyngoesophageal (Zenkers) diverticulum in a 91‐year‐old woman. Sonography of the thyroid gland showed diffuse enlargement of the gland and a well‐defined, heterogeneous hyperechoic mass that appeared to be in the posterior left lobe. The mass had a smooth hypoechoic wall with a layered appearance anteriorly. Real‐time sonography performed during the patients ingestion of water showed transient changes in the size, margins, and echogenicity of the lesion, which subsequently reverted to its original appearance.

Urogenital ultrasound : a text atlas

Contributors Preface Acknowledgements 1. Basic (Clinically Oriented) Principles of Doppler: Types of Doppler scanner, Spectral analysis, Spectral Doppler artefacts, Colour Doppler imaging, Colour artefacts, Normal Doppler waveform patterns, Abnormal Doppler waveforms patterns. 2. The Kidney: General considerations, Congenital abnormalities of the kidney, Acquired renal disease. 3. The Renal Transplant: General considerations, Normal appearances, Complications of renal transplantation, Surgical complications, Medical complications, Summary 4. Combined Renal and Pancreatic Transplantation: Early complications, Ultrasonic scanning technique, Normal ultrasound appearances, Conclusion. 5. Renal Dialysis: General considerations, Peritoneal dialysis, Haemodialysis, General dialysis complications 6. The Scrotum: General considerations, Applications, Scrotal anatomy, Ultrasound technique, Testicular tumours, Benign testicular disease, Testicular size The Penis: Applications, Anatomy and technique, Erectile dysfunction, Other penile pathologies, Ultrasound of the male anterior urethra 8. The Prostate and Seminal Vesicles: Prostatic embryology and zonal anatomy, Instrumentation and examination, Normal sonographic prostate anatomy, Prostate cancer, Sonographic features of prostate cancer, Extracapsular extension and seminal vesicle invasion, Colour Doppler evaluation of the prostate, Benign prostatic hyperplasia, Inflammation, Prostatic cysts, Abnormalities of the seminal vesicle, Conclusion 9. Bladder and Urethra: Introduction, Embryology, Sonographic technique and anatomy, Congenital anomalies, Acquired abnormalities, Urethra, Summary, 10. The Retroperitoneum and Ureters: Applications, Anatomy and technique, Retroperitoneal fibrosis, Pelvic lipomatosis, The aorta, The inferior vena cava, The adrenal glands, Other retroperitoneal tumours (excluding renal and adrenal), The ureters, Other pathologies that may cause ureteric obstruction, Renal pathologies affecting the retroperitoneum 11. Paediatric Urological Ultrasound: General considerations, Postnatal imaging of infants with antenatally detected nephrourological disorders, Cystic renal disease, Medical renal disease, Renal infection, Renal tumours, Bladder, Retroperitoneum and adrenals 12. Interventional Ultrasound: General considerations, Technique, Renal biopsies, Biopsies of other sites, Antegrade pyelography, drainage and stent insertion, Lithotripsy Index

Screening for chromosomal abnormality

Screening for fetal abnormalities has become one of the most high profile health care issues of modern times. This issue is predicated on major advances in health care technology that permit wider detection of fetal anomalies, including the development of more advanced biochemical markers and improvements in ultrasound imaging. The effectiveness of these screening methods and their rational application is a point of great controversy, and is the cause of considerable unease in clinical obstetrical practice. This article reviews the general concepts of fetal screening for fetal chromosome abnormalities and then focuses on certain aspects of ultrasound screening that are particularly controversial. The scientific basis for each ultrasound finding (e.g., nuchal translucency) is reviewed, as well as the frequently divergent clinical experience with the finding. Finally, a plea is made for the development of a more scientific database for fetal ultrasound screening, and the setting of fetal screening guidelines for practicing physicians based on diagnostic accuracy and cost-effectiveness.

MRI appearances of acute idiopathic scrotal oedema in an adult.

Acute idiopathic scrotal oedema is an uncommon cause of acute painless scrotal swelling that is usually seen in children. Traditionally, ultrasound has been used to help establish the diagnosis in the appropriate clinical setting. We report the MRI appearances of acute idiopathic scrotal oedema in a 51-year-old male with associated involvement of the penis.

Polycystic Ovary Syndrome: Where Are We Now?

In 1935, a specific ovarian morphology of cystic and enlarged ovaries was described at laparotomy in seven women with obesity, amenorrhea or menstrual irregularity, hirsutism, and infertility. In several further studies in the 1950s and ‘70s, specific endocrine features of increased luteinizing hormone levels and hyperandrogenemia were described in these women. In the early ‘70s, with the availability of ultrasonography (US), noninvasive assessment of the ovaries was possible and, in 1985, a characteristic US appearance of polycystic ovaries was described. However, debate has remained concerning the correlation between the finding of polycystic ovaries on US and the clinical phenotype—some studies have shown that as many as 33% of apparently normal women will have polycystic ovaries. The etiology of polycystic ovary syndrome (PCOS) is also unknown. In 1935, Stein and Leventhal suggested a primary ovarian defect; however, more recently, a lot of interest has been focused on the role of insulin resistance as a common unifying hypothesis for the varied manifestation of this syndrome. Insulin resistance also has wider health implications such as diabetes, hypertension, and cardiovascular disease, and researchers are trying to quantify the risks of these conditions in PCOS. Therapy has evolved from a philosophy of primarily targeting the presenting clinical problem to ameliorating insulin resistance, which is now thought to be the primary defect. Improving insulin resistance has been shown to improve periods, fertility, and hyperandrogenemia. However, there remains some controversy as to the exact origin of this syndrome and it is still unknown which came first, “the insulin or the egg.”

Screening for gynecological malignancy

Treatment for gynecological malignancy depends for its efficacy at least in part on the stage at presentation. Earlier diagnosis would allow the opportunity for more effective and potentially curative treatment. As a consequence, and in common with initiatives for many other cancers, a search for effective methods of screening is a high priority for the detection of early gynecological cancer. Such methods already exist for cervical cancer, and in many countries screening programs are in place to provide such early diagnosis. Patients with endometrial cancer often present symptomatically at stage I and as a consequence the value of screening of asymptomatic patients may be of lesser importance than for other cancers. Ovarian cancer, however, characteristically presents late and is insidious in onset and progress. Transvaginal ultrasound, together with serum tumor markers, may offer the possibility of early diagnosis and modification of therapy with the potential for improved outcome. However, the evidence from the literature is at present confusing, and it is worthwhile to review the current status of research data to evaluate the place of screening procedures for ovarian and other gynecological malignancies.

Detection of Free Intraperitoneal Fluid in Healthy Young Men

Free intraperitoneal fluid is a secondary sign of abdominal disorders. The detection of small volumes of fluid has been documented as a normal finding in women of childbearing age and also in pediatric sonography. However, the finding of free fluid in asymptomatic men has not been similarly documented by sonography. We postulate that with high‐frequency linear probes, small volumes of fluid may be detected in asymptomatic men without underlying abdominal disorders.