Richard H. Picker

Assessment of ovulation by ultrasound and estradiol levels during spontaneous and induced cycles.

Both Graafian follicle growth and subsequent ovulation were studied in 45 menstrual cycles of 28 patients by the estimation of plasma estradiol levels and by the measurement of follicle size and number by ultrasound. Twenty spontaneous ovulatory cycles were studied as controls compared with twenty cycles in which ovulation was induced by clomiphene and five cycles in which ovulation was induced by human pituitary gonadotropin. The means of the peak estradiol levels during the cycles in which one follicle was present were 1553.1 +/- 87.8 pmoles/liter in the spontaneous cycles and 2296.8 +/- 163.4 pmoles/liter in the clomiphene-treated cycles. Ultrasound was shown to be complementary to endocrine profiles because the number and diameter of Graafian follicles could be measured accurately by this technique.

Implanon implant detection with ultrasound and magnetic resonance imaging

Objective: The objective of the present study was to determine the degree of difficulty in locating Implanon (Organon, Sydney, Australia) contraceptive rods which had been inserted suboptimally, using both ultrasound and magnetic resonance imaging (MRI).

A simple geometric method for determining fetal weight in utero with the compound gray scale ultrasonic scan

A method to estimate intrauterine fetal weight by calculating fetal volume from simple parameters measured on echograms is described. The comparison between assesed weight of 50 fetuses and actual birth weight is presented.

The localization of parathyroid tissue by ultrasound scanning prior to surgery in patients with hyperparathyroidism

Ultrasonic localization of parathyroid tissue has been attempted in 24 patients with hyperparathyroidism prior to surgical exploration of the neck. All 24 patients had biochemically proven hyperparathyroidism. Standard contact diagnostic ultrasound equipment fitted with a 5 MHz transducer was used, and transverse and longitudinal scans of the region of the thyroid gland were performed at 5 mm intervals. The normal anatomical structures identified were the lobes of the thyroid gland, trachea, common carotid arteries, and jugular veins. The longus colli muscle on each side was used as a major landmark. These structures define the site where most parathyroid glands are found in the neck. In 18 of the 24 patients the suspected parathyroid tumor was visualized preoperatively and confirmed at operation. The abnormal glands ranged in size from 5 to 12 mm in transverse diameter. In 3 patients false-positive diagnoses were made by ultrasound; at operation the abnormalities proved to be thyroid nodules protruding from the posterior surface of the thyroid gland. Ultrasonography is of little value in the presence of multinodular goiter. Three adenomas and 3 hyperplastic parathyroid glands greater than 5 mm in diameter were not identified. Localization of enlarged parathyroid glands by echography may be difficult when normal anatomical landmarks are altered by the presence of multinodular goiter or because of previous surgery. The sensitivity of this technique for identifying in the neck parathyroid glands larger than 5 mm in diameter was found to be 79.3% with 11.5% false-positive and 8.6% falsenegative results.Ultrasonic localization of parathyroid tissue has been attempted in 24 patients with hyperparathyroidism prior to surgical exploration of the neck. All 24 patients had biochemically proven hyperparathyroidism. Standard contact diagnostic ultrasound equipment fitted with a 5 MHz transducer was used, and transverse and longitudinal scans of the region of the thyroid gland were performed at 5 mm intervals. The normal anatomical structures identified were the lobes of the thyroid gland, trachea, common carotid arteries, and jugular veins. The longus colli muscle on each side was used as a major landmark. These structures define the site where most parathyroid glands are found in the neck. In 18 of the 24 patients the suspected parathyroid tumor was visualized preoperatively and confirmed at operation. The abnormal glands ranged in size from 5 to 12 mm in transverse diameter. In 3 patients false-positive diagnoses were made by ultrasound; at operation the abnormalities proved to be thyroid nodules protruding from the posterior surface of the thyroid gland. Ultrasonography is of little value in the presence of multinodular goiter. Three adenomas and 3 hyperplastic parathyroid glands greater than 5 mm in diameter were not identified. Localization of enlarged parathyroid glands by echography may be difficult when normal anatomical landmarks are altered by the presence of multinodular goiter or because of previous surgery. The sensitivity of this technique for identifying in the neck parathyroid glands larger than 5 mm in diameter was found to be 79.3% with 11.5% false-positive and 8.6% falsenegative results.

An experience of laparoscopic and transvesical oocyte retrieval in an in vitro fertilization program

Successful pregnancies have been achieved after in vitro fertilization of oocytes obtained by an ultrasound-guided transvesical approach, as well as with the traditional laparoscope. With the use of the same laboratory facilities, success rates for each retrieval method were evaluated in an established in vitro fertilization program. There was a significantly increased cancellation rate and a decrease in oocyte/follicle rate in the transvesical group, but there was a greater fertilization rate with possible improved embryo quality. Although the transfer rates were similar, the pregnancy rate appeared lower in the transvesical group. A valid comparison of these data is not possible because the two groups are dissimilar for factors known to influence oocyte development and recovery. Different criteria were applied to patient selection and treatment, and operation expertise differed between the two groups.

Ultrasound in Gonadotrophin Therapy: A Better Predictor of Ovarian Hyperstimulation?

A case of ovarian hyperstimulation as a result of gonadotrophin therapy is reported. This occurred despite close ultrasonic monitoring in the absence of hormonal profiles.

Oocyte pickup by laparoscopy replaced by transvaginal aspiration in an in vitro fertilization program

The results of laparoscopic (lap) and transvaginal (TV) oocyte pickups (OPUs) performed concurrently for in vitro fertilization in 232 consecutive treatment cycles have been reviewed. The patients were compared for age, preoperative estradiol concentration, luteal-phase support, and number of follicles aspirated and were found to be similar but were not matched for cause of infertility. The lap OPU group had more oocytes recovered per follicle aspirated (P<0.001), but because of a lower fertilization rate (P<0.01), the number of embryos transferred was similar. Nevertheless, more (P<0.05) pregnancies occurred in the TV OPU group. Patients were subgrouped so that comparisons of patients with the same cause of infertility, tubal disease alone, were considered. This showed that the pregnancy rate was still higher in the TV OPU group (P<0.05). TV OPU was less painful and not associated with increased morbidity, and since the data suggest that TV OPU was at least as successful as lap OPU, it is recommended that all oocyte pickups in the future be performed transvaginally.

A review of 2,003 consecutive amniocenteses performed under ultrasonic control in late pregnancy.

Summary: A review of 2003 consecutive amniocenteses performed in late pregnancy under ultrasonic control is presented. No perinatal mortality was encountered. On this evidence the method described is suggested to be the safest available for obtaining liquor in late pregnancy.

Ultrasound in the Management of Threatened Abortion

Summary: The use of grey scale B‐mode ultrasonography at the Royal North Shore Hospital of Sydney in the management of suspected threatened abortion is described. The results obtained with this technique indicate that it is a rapid, reliable means of evaluation of bleeding per vaginam in the first 20 weeks of pregnancy, and should be considered as part of the routine investigation of threatened abortion.

Stromal Sarcoma of the Endometrium Complicated by Pregnancy

Summary: A rare case of stromal cell sarcoma of the uterus complicated by pregnancy is described. The nomenclature of uterine mesenchymal sarcomata is discussed.