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A C Fleischer

Publications and source records attributed to A C Fleischer.

At least 55 records · Page 3Linked to original sources
PubMed1991

New applications of pelvic sonography.

This review discusses and illustrates the many applications of transvaginal sonography in gynecology. TVS has improved the accuracy of evaluation of pelvic masses and affords a means for accurate guided aspiration. The accuracy of follicular monitoring and aspiration is also enhanced with transvaginal sonography. The possible applications of transvaginal sonography as a means for screening for early ovarian carcinoma is also discussed as well as applications involving evaluation of the uterus and endometrium.

Female↗
PubMed1991

Duplex Doppler sonography of the umbilical arteries: predictive value in IUGR and correlation with birth weight.

Forty-three women with either clinically high-risk singleton pregnancies or a predicted fetal weight less than the 10th percentile were studied in their third trimester by duplex Doppler sonography of the free umbilical artery to assess the associations between umbilical arterial flow resistance and intrauterine growth retardation (IUGR) and birth weight. Test criteria included: the greatest (GRI), mean (MRI), and least (LRI) resistive index. The criterion with the strongest association with IUGR (p = 0.001) was the parameter of the LRI predicting IUGR). Linear regression analysis showed a nonsignificant correlation between RI and percentile birth weight, with r2 = 0.05 and p = 0.131. While significant associations can be shown between RI and IUGR, the clinical use of the results of this test should reflect the imprecise nature of these correlations.

Birth Weight↗
PubMed1991

Transabdominal and transvaginal sonography of ovarian masses.

This chapter outlined the sonographic appearances of most ovarian tumors using both transabdominal and transvaginal sonography. The use of transabdominal and transvaginal sonography for the early detection of ovarian carcinoma seems promising and should be pursued in several institutions as clinical trials.

Abdomen↗
PubMed1991

Pulmonary sequestration: diagnosis with color Doppler sonography and a new theory of associated hydrothorax.

The diagnosis of pulmonary sequestration has traditionally relied on angiographic demonstration of a systemic artery to the sequestered lung tissue. Rarely, extralobar sequestration can be associated with tension hydrothorax, which in the past has invariably led to fetal hydrops and death. The authors report the cases of three infants who had initially undergone color and spectral Doppler analysis; in two of them, extralobar sequestrations were associated with congenital hydrothorax. All three patients underwent surgical resection and histopathologic evaluation of their sequestrations. On the basis of the findings, the authors believe that torsion of the sequestration occludes the efferent venous and lymphatic channels, initiating the accumulation of pleural fluid and subsequent hydrops through systemic venous obstruction. Color Doppler made possible the identification of minute feeding vessels, obviating further diagnostic studies.

Bronchopulmonary Sequestration↗
PubMed1991

Assessment of ovarian tumor vascularity with transvaginal color Doppler sonography.

This report describes the results of transvaginal color Doppler sonography (TV-CDS) of 43 surgically proved ovarian masses. Waveform analyses of the signals arising from specific vessels (i.e., peripheral, central, septal) adjacent to and within these masses were correlated to those seen on macroscopic pathologic evaluation. The mean and standard deviation of the pulsatility indices (PI) of 32 benign lesions (1.8 +/- 0.8) were higher than 11 malignant ones (0.8 +/- 0.6) (P = 0.03). However, the range of benign (4.0 to 0.7) and malignant (1.5 to 0.4) lesions did overlap. Low PIs (less than 1.0) were found in five relatively benign lesions (one case each of dermoid cyst, cystadenoma containing a dermoid cyst, endometrioma, benign sclerosing stromal tumor, and thecoma), but also in all 11 malignant or borderline malignant lesions (nine cystadenocarcinomas, two germ cell tumors), causing an overlap between the PIs of some benign and malignant masses. With a 100% negative predictive value, our preliminary data suggest that TV-CDS can effectively exclude malignancy. However, with a positive predictive value of 73%, one in four malignant lesions diagnosed by TV-CDS will be benign.

Adolescent↗
PubMed1991

Transvaginal sonography of the endometrium during induced cycles.

The thickness and texture of the endometrium as depicted by transvaginal sonography were assessed in 23 patients who underwent a similar ovulation induction protocol including a gonadotropin-releasing hormone analogue (Lupron) and human menopausal gonadotropin (Pergonal). In the 9 patients who conceived, a multilayered endometrium was more frequently present than in the 14 who did not, even though the number of mature follicles, oocytes retrieved and transferred, and estradiol values were similar.

Endometrium↗
PubMed1991

Variation in the size and number of stone fragments after gallbladder lithotripsy.

Ninety-four gallbladder ultrasound examinations were carried out in 11 patients at intervals for the first 40 days after lithotripsy. No dissolution or other active therapy was carried out during this time. Fragment size and number were measured to determine the postlithotripsy variability. Analysis of variance (ANOVA) showed no significant changes in fragment size or number over time. The changes in fragment size and number compared to the previous measurements were then evaluated. Again, ANOVA showed no significant changes between times. The average change in absolute size was 3.1 +/- 0.6 mm, and the average change in absolute number was 1.4 +/- 0.5. We conclude that fragment size and number as determined by ultrasound do not vary significantly with time during the first 40 days. The absolute size change measured to the nearest millimeter should be at least 4 mm to surpass the 95% confidence interval. Similarly, the absolute change in number should be at least 2 to be regarded as significant.

Analysis of Variance↗
PubMed1991

New applications of conventional and Doppler sonography in pediatrics.

Sonography is assuming an increasingly dynamic role in pediatric diagnosis. The small size of the patient and the use of short-focus, higher frequency transducers, coupled with continuous improvement in sonographic equipment, provide remarkably detailed images. The introduction of Doppler technology has catapulted sonography from the realm of purely anatomic information to that of physiologic and angiographic data. In neurosonography, there has been refinement of the nomenclature, quantification, and prognosis of intracranial hemorrhage and ischemic disorders. Doppler technology has helped us in understanding the vascular dynamics that occur after acute interruption of right internal carotid flow in patients who undergo extracorporeal membrane oxygenation. In abdominal diagnosis, sonography is also playing an increasingly important role in assessing both gastrointestinal and renal conditions. This review outlines some of the important concepts underlying pediatric sonography today and reviews some salient contributions of recent literature.

Blood Vessels↗
PubMed1990

Transvaginal scanning of the endometrium.

Transvaginal sonography (TVS) can accurately depict the anteroposterior, width, and long axis of the endometrium. This article describes and illustrates normal and abnormal endometria as depicted by TVS.

Decidua↗
PubMed1990

Depth of myometrial invasion in endometrial cancer: preoperative assessment by transvaginal ultrasonography.

Twenty-five patients with cancer of the uterus underwent transvaginal sonography (TVS) to assess depth of myometrial invasion. All scans were performed with a 5.0-MHz curvilinear array probe (Toshiba, Inc., Tustin, CA) within 1 week of hysterectomy. In 21 cases (84%) sonography correctly predicted the depth of invasion (within 15% of actual). Only one of three cases with cervical involvement was detected. Transvaginal sonography can accurately detect depth of myometrial invasion and is well suited as a screening test to detect high-risk patients for consultation or referral.

Female↗
PubMed1990

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.

Adnexa Uteri↗
PubMed1990

Intraoperative guidance for intrauterine procedures with transrectal sonography.

Transrectal sonography was used for intraoperative guidance in intrauterine tandem placement for intracavitary radiation therapy and in dilation and curettage procedures. The authors describe the method and three representative cases in which it was applied. It is concluded that the technique may prevent complications such as uterine perforation or bladder injury in tandem placement, and that it can facilitate dilation and curettage in complicated cases.

Aged↗
PubMed1990

Transvaginal sonography of postmenopausal ovaries with pathologic correlation.

The sonographic appearance of 67 ovaries in 34 postmenopausal women who underwent preoperative transvaginal sonography (TVS) was correlated to findings on pathologic examination. Both ovaries were detected by TVS in 60% of the women examined; in 85%, at least one ovary was detected. The size of the normal, sonographically visualized postmenopausal ovary was 2.2 +/- 0.7 cm in transverse, 1.2 +/- 0.3 cm in anteroposterior, and 1.1 +/- 0.6 cm in longitudinal axes, with an average volume of 2.6 +/- 2.0 cm3. The average size of ovaries that were not detected by TVS was 0.7 x 0.4 cm (range, 0.3 to 1.3 cm); most of these (five of six) were atrophic on pathologic exam. The difference between actual and sonographically measured size was negligible (TVS overestimated by 0.3 cm). Four simple cysts that ranged from 0.5 to 3.5 cm were found by TVS and confirmed pathologically, as were three benign serous cystadenomas that ranged from 2.5 to 3.5 cm, one 3 x 6-cm tubal carcinoma, and one 1 X 4-cm paratubal cyst. TVS missed a 6-cm dermoid, a 2.5-cm cystadenoma, a 0.8-cm Sertoli cell tumor, and a 0.5-cm fibrothecoma that were nonpalpable but that were found on pathologic examination. None of the missed lesions were palpable preoperatively. The positive predictive value was 94% for detection of an ovarian mass; the negative predictive value for exclusion of an ovarian lesion was 92%. It is concluded that TVS can accurately delineate the ovaries in most, but not all, postmenopausal women and that only rarely will pathologic lesions not be detected by TVS.

Aged↗
PubMed1990

Prenatal diagnoses in unilateral empty renal fossa.

Six cases of unilateral empty renal fossa diagnosed by obstetric sonography are described. The anomalies reported (ectopic kidney, cross-fused ectopic kidney, and unilateral renal agenesis) have not yet been described in the prenatal literature, to our knowledge, in fetuses that are otherwise normal. The study also demonstrates that, in spite of their nonvital in utero role, single kidneys may show compensatory hypertrophy.

Female↗
PubMed1990

Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria.

Four sonographic diagnostic criteria for appendicitis, (1) any visualization, (2) appendiceal diameter greater than 6.0 mm, (3) muscular wall thickness greater than or equal to 3.0 mm, and (4) presence of a complex mass, were compared in a series of 200 patients clinically suspected of having appendicitis. The diagnosis of appendicitis was confirmed histopathologically and included all forms of appendicitis with mucosal invasion by inflammatory cells. The sensitivities of all the criteria were low (11% to 75%) and the usefulness of this test as a screening procedure is questioned. The combined criteria of an appendix with a muscular wall thickness (MWT) greater than or equal to 3.0 mm and visualization of a complex mass (CM) separate from the adnexa in females proved most useful as a diagnostic test (sensitivity, 68%; specificity, 98%). We conclude that the diagnosis of appendicitis is still difficult, despite the addition of graded compression ultrasound as a diagnostic test. We do not recommend its use as the only screening test, but do recommend it, rather, in a diagnostic role after the initial clinical screening.

Abdominal Pain↗