Zvi Appelman

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women

OBJECTIVE To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women. DESIGN A prospective study. SETTING Tertiary hospital-based ultrasonographic unit. PATIENT(S) Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel. INTERVENTION(S) Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered. MAIN OUTCOME MEASURE(S) Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up. RESULT(S) For the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases. CONCLUSION(S) Premenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

The contribution of transvaginal ultrasound in the diagnosis of acute appendicitis: an observational study

To assess the contribution of transvaginal and transabdominal sonography in the diagnosis of acute appendicitis.

High cytomegalovirus IgG avidity is a reliable indicator of past infection in patients with positive IgM detected during the first trimester of pregnancy.

Abstract Objective: To evaluate the accuracy of high cytomegalovirus (CMV) specific IgG avidity in excluding recent infection in patients with anti-CMV IgM antibodies detected during the first trimester, using amniotic fluid obtained by standard amniocentesis. Methods: Records of all patients with a positive anti-CMV IgM with IgG avidity >65% detected during pregnancy were reviewed. Amniocentesis for CMV assessment was offered to all patients. The presence of the virus in amniotic fluid was determined by polymerase chain reaction (PCR) and shell vial testing. Results: Seventy-nine patients with a positive CMV IgM-high IgG avidity combination were identified. The serological tests were performed during the first trimester in 65 (82.3%) patients, of which 28 consented and underwent amniocentesis. All amniotic fluid samples were negative for CMV-PCR and CMV shell vial testing. Conclusions: IgG avidity above 65% is a good indicator of past infection, and thus excludes CMV in the amniotic fluid. In such circumstances, invasive prenatal diagnosis may eventually not be required. This optimistic conclusion, however, needs to be confirmed by large scale studies.

Sonographically guided aspiration of ovarian cyst with simple appearance.

The objective of this study was to evaluate the role of sonographically guided aspiration of simple ovarian cysts. During the period from 1985 through 1992, 107 ultrasonographically guided punctures of apparently simple ovarian cysts were performed. The group included 76 premenopausal and 31 postmenopausal women who were followed for 1 to 6 years (mean, 2.7 years) after initial cyst puncture. In 42 cases, cyst aspiration constituted the definitive therapy. In 65 cases the cyst recurred and in this group, 38 women (with complete recurrence) were operated on whereas 27 women with a cyst less than 5 cm (incomplete recurrence) were allocated to a follow‐up group. Overall, in 69 cases (65%) surgery was avoided. No major complications were encountered. In our experience, aspiration of simple ovarian cysts is a suitable alternative in the management of this problem. Close follow‐up is necessary to detect recurrence and perform surgical intervention when indicated.

Chorionic villus sampling in multiple pregnancies.

Prenatal genetic diagnosis is recommended in multiple pregnancies because of the increased prevalence of genetic abnormalities in such fetuses. It can be done early by chorionic villus sampling or later by amniocentesis. Several studies have demonstrated the efficacy and safety of chorionic villus sampling in multiple pregnancies. Our study describes the results of this method in a twin pregnancy and in 3 triplet pregnancies, which represent 3% of the chorionic villus samplings performed in our ultrasound unit during 1989-95. All genetically deformed fetuses in these pregnancies were identified by chorionic villus sampling and the method was not associated with fetal loss. Our results confirm the safety and efficacy of chorionic villus sampling as expressed in the world literature.

Lateral Distribution of Ovarian Dermoid Cyst

STUDY OBJECTIVE To determine the distribution of ovarian dermoid cysts in a large series of women. DESIGN Observational study (Canadian Task Force classification II-3). SETTING University teaching hospitals. PATIENTS Three hundred thirty-six women. INTERVENTION Evaluation of operative reports. MEASUREMENTS AND MAIN RESULTS Dermoid cysts had a mean diameter of 5.6 cm. They were present in the right ovary (48.8 %), left ovary (37.8%), and bilaterally (13.4%). Unilateral cysts were more frequent in the right ovary (56.4%) than in the left (p = 0.002, odds ratio 1.7, confidence interval 1.2-2.3). This was significantly different from the expected 50% (4.45, chi2). A similar predisposition was found when we included women with bilateral cysts (p < 0.01, OR 1.5, CI 1.1-1.9). Patient age and size of cyst did not differ between those with left and right lesions. CONCLUSION In this large cohort of women, ovarian dermoid cysts had a predisposition to a right lateral location.

Variable Echogenicity as a Sonographic Sign in the Preoperative Diagnosis of Ovarian Mucinous Tumors

Objective. The purpose of this study was to evaluate the reliability of the “variable echogenicity” sign in the preoperative sonographic diagnosis of ovarian mucinous tumors. Methods. Variable echogenicity was detected sonographically in different compartments of 8 adnexal multilocular masses. This finding was correlated with the final histologic results. Results. All 8 tumors were mucinous cyst adenomas. In 3 of them, borderline malignancy was present. Conclusions. The sonographic detection of variable echogenicity in the contents of an adnexal multilocular cyst strongly suggests a mucinous tumor.

Alcohol sclerotherapy for successful treatment of focal adenomyosis: a case report.

Adenomyosis is characterized by the presence of ectopic endometrial tissue within the myometrium. Treatment options range from use of non‐steroidal anti‐inflammatory drugs and hormonal suppression for symptomatic relief, to endometrial ablation or even hysterectomy. We report a case of successful ultrasound‐guided aspiration of focal adenomyosis with intracavitary alcohol instillation in a patient with a recurrent intramural uterine lesion. This is the first report of the treatment of sclerotherapy by alcohol instillation, which may be considered as a reasonable alternative modality in treating rare cases of symptomatic adenomyosis. Copyright

“Onion skin” sign in an ovarian mucinous cyst

The sonographic “onion skin” sign was initially described as concentric echogenic layers in mucinous tumors unrelated to the female reproductive system. Typically, the sonographic appearance of ovarian mucinous cystadenoma includes numerous septa and fine, gravity‐dependent echoes. We present a case of the “onion skin” sign in a mucinous ovarian tumor.

OC12.08: Clinical significance of antenatal sonographic diagnosis of a nuchal cord at term: double‐blind prospective study

17–40 gws (p = 0.012). The cervix was larger in multiparae (median 38 cm3 vs. 32 cm3 at 17–40 gws, p < 0.0001; median 31 cm3 vs. 22 cm3 at 41 gws p = 0.288). FI did not differ between nullipara and multipara and remained unchanged between 17 and 41 gws (median 30.6, range 21.2–55.2). VI and VFI did not change unequivocally from 17 to 41 gws, but the values were higher in multipara at 17–30 gws (at 17–30 gws median VI 5.3 vs. 3.1, median VFI 1.6 vs. 0.9; at 31–40 gws median VI for all women 4.8 and median VFI for all women 1.4; at 41 gws median VI for all women 5.6 and median VFI for all women 1.6). Conclusion: Reference values for cervical volume and blood flow indices as assessed by 3D power Doppler ultrasound have been established. These lay the basis for studies of pathological conditions.