Search PubMed⌕ Search

Biomedical subjects

A Kurjak

Publications and source records attributed to A Kurjak.

At least 55 records · Page 3Linked to original sources
PubMed1998

Parallel Doppler assessment of yolk sac and intervillous circulation in normal pregnancy and missed abortion.

This study assessed yolk sac morphology and vascularity and intervillous blood flow in normal early pregnancy and missed abortion. Transvaginal colour and pulsed Doppler were used in a prospective analysis of 87 normal pregnancies and 48 missed abortions between 6 and 12 weeks gestation. The Kruskal-Wallis rank test was used to calculate the difference in yolk sac diameter and vascularity visualization rate between gestational weeks. Repeated measures analysis of variance was used for comparison of the intervillous circulation between groups. The growth of the yolk sac was considered statistically significant between gestational weeks 6 and 9, being most prominent between 9 and 10 weeks of gestation. Vascularity of the yolk sac, characterized by low velocity and absence of diastolic flow, was demonstrated in 67 per cent of normal pregnancies. Yolk sac blood flow was detected in 19 per cent of the patients with missed abortion. Doppler analysis of the intervillous circulation demonstrated decreased peak velocity of the continuous flow in patients with missed abortion for gestational weeks 11 and 12. It is concluded that progressive decrease of yolk sac vascularity coincides with visualization of more prominent colour-coded areas within the intervillous space. In patients with missed abortion, such changes do not occur.

Abortion, Missed↗
PubMed1998

Septate uterus: detection and prediction of obstetrical complications by different forms of ultrasonography.

The aims of the study were to compare the accuracy of transvaginal ultrasonography, transvaginal color Doppler sonography, hysterosonography, and three-dimensional ultrasonography in detection of septate uterus and to evaluate the occurrence of obstetrical complications in relation to septal dimension and vascularity. Each patient underwent transvaginal ultrasonography and color Doppler examination, whereas hysterosonography and three-dimensional ultrasonography were carried out in 76 and 86 patients, respectively. The sensitivity of different sonographic imaging modalities ranges between 95.21% and 99.29%. Color and pulsed Doppler sonographic studies of the septal area revealed vascularity in 71.22%. Patients with vascularized septa had a higher prevalence of obstetrical complications than those with avascularized septa (P < 0.05). Three-dimensional ultrasonography and hysterosonography are highly accurate diagnostic tools for detection of uterine septa. We found no correlation between septal dimension and rate of obstetrical complications, although pregnancy loss was most likely to occur in patients with vascularized septa.

Female↗
PubMed1998

Intervillous blood flow in patients with missed abortion.

AIM: Analysis of the color Doppler features of intervillous flow in cases of missed abortion, and their comparison with the findings in normal pregnancy. METHODS: Transvaginal color and pulsed Doppler was used in the analysis of 38 patients with missed abortion and 40 patients with normal pregnancy. The gestational age ranged from 6 to 11 weeks. Repeated analysis of variance was used to compare the groups. RESULTS: Two types of Doppler signals were detected in the intervillous space: pulsatile and continuous. Impedance in the intervillous space of both groups did not change significantly with the gestational age. For the group with missed abortion, the mean resistance index (RI) was 0.37 +/- 0.03 and pulsatility index (PI) 0.75 +/- 0.07. For the control group, the mean RI was 0.36 +/- 0.02 and PI 0. 72 +/- 0.04. The differences in RI and PI for all gestational age groups and between the two patient groups were not statistically significant. With advancing gestation, continuous, venous-like signal became stronger and randomly dispersed throughout the placenta. Peak flow velocity values obtained from both groups did not change significantly with gestational age, nor between the two groups. Conclusion. The new generation of sensitive Doppler units can detect the intervillous flow as a continuous progressive process at 6-11 weeks of gestation. The vascular resistance in the intervillous space does not change in cases of missed abortion.

Abortion, Missed↗
PubMed1998

Diagnosis and treatment outcome of the septate uterus.

AIM: To compare the accuracy of transvaginal ultrasound, transvaginal color Doppler, hysterosonography, and three-dimensional ultrasound in the detection of septate uteri. To evaluate obstetrical prognosis of the septate uterus and to assess the reproductive outcome following operative hysteroscopy. PATIENTS AND METHODS: Four hundred and twenty infertile patients undergoing hysteroscopy were evaluated prospectively during a 4 year period. Transvaginal ultrasound and color Doppler were performed in all patients, whereas hysterosonography and three-dimensional ultrasound were used in 76 and 86 patients, respectively. RESULTS: The sensitivity of transvaginal ultrasound and transvaginal color Doppler in the identification of the septate uterus was 95.0% and 99.3%, respectively. Color and pulsed Doppler studies of the septal area revealed vascularity in 71.2%. The sensitivity of hysterosonography and three-dimensional ultrasound in the detection of the septate uterus were 100% and 93.6%, respectively. However, the latter method predicted the existence of a congenital uterine defect in all the patients with septate uterus, but was inaccurate in differentiating it from other fusion anomalies. The pregnancy rate in 116 patients following the operative hysteroscopy for an intrauterine septum in a prospective follow-up period of 24 months was 50.9%: 44 patients (74.6%) had term deliveries, 11 (18.6%) had first trimester abortion, and 4 (6.8%) had preterm delivery. CONCLUSIONS: Transvaginal color Doppler and hysterosonography are highly accurate diagnostic tools for preoperative evaluation of the uterine cavitary defects. Three-dimensional ultrasound increases the accuracy of conventional two-dimensional transvaginal scan, allowing precise reconstruction of the uterine cavity. Removing the intrauterine septum in patients suffering from infertility and recurrent pregnancy wastage is beneficial.

Adult↗
PubMed1997

Doppler assessment of the intervillous blood flow in normal and abnormal early pregnancy.

OBJECTIVE: To compare resistance index (RI) and pulsatility index (PI) in the spiral and intervillous arteries, and peak systolic velocity of the continuous intervillous flow in normal and abnormal first-trimester pregnancy. METHODS: Transvaginal color and pulsed Doppler were used in a prospective analysis of 60 normal (controls) and 54 abnormal (30 missed abortions and 24 anembryonic) pregnancies (6-12 weeks' gestation). Repeated-measures analysis of variance was used for comparison between groups. RESULTS: A gradual decrease in spiral artery RI and PI was found in women with anembryonic pregnancies. No difference in spiral artery impedance was noted in women with normal pregnancies, but there was a progressive increase in spiral artery RI and PI in women with missed abortion. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward in the normal pregnancy group (8.0 +/- 0.9 versus 12.2 +/- 1.4 cm/second). Intervillous arterial blood flow signals did not demonstrate any difference in RI and PI with advancing gestational duration. Significantly lower PI values were obtained from the intervillous arteries in women with anembryonic pregnancy (PI 0.54 +/- 0.04) than in controls (PI 0.80 +/- 0.04) and those with missed abortions (PI 0.75 +/- 0.04). However, there was no statistically significant difference in the intervillous RI between subgroups. CONCLUSION: The new generation of sensitive Doppler units can detect intervillous flow as a continuous progressive process during the first trimester of normal and abnormal pregnancy. There is a significant difference in intervillous artery vascular impedance between normal and anembryonic pregnancies.

Adult↗
PubMed1997

A combined Doppler and morphopathological study of ovarian tumors.

OBJECTIVE: To evaluate intratumoral blood flow in 46 patients with ovarian masses. METHODS: Transvaginal color Doppler was carried out in each patient prior to the laparoscopy or laparotomy. Tumors were analyzed according to the size, morphology, presence of the neovascularization, configuration and distribution of the tumoral blood vessels and pattern of the intratumoral blood flow. Vascular patterns of surgically removed tumors were studied microscopically. Three types of vasculature were analyzed: neovascular capillaries without media, sinusoidal thin walled spaces and normal vessels' morphology. The RI (resistance index) values were analyzed in relation to gross appearance, histological type of the tumor, existence of inflammation/necrosis area and vascularization pattern of the tumor. RESULTS: Neovascularization was found in all the malignant tumors with low RI (less than 0.42) and solid or solid cystic gross morphology. Neovascular signals were obtained in only one patient with ovarian endometrioma. Sinusoidal spaces were identified in all the malignant ovarian tumors, but also in most of the benign lesions. Normal vessel morphology was identified in 60% of malignant ovarian tumors and in all the patients with benign ovarian lesions. CONCLUSION: There is a significant correlation between Doppler and histopathological studies in terms of vascularization pattern analysis (detection of neovascular capillaries, sinusoidal spaces and normal vessels morphology). In most of the malignant ovarian tumors there were few areas of vascularization which can be analyzed non-invasively by transvaginal color and pulsed Doppler ultrasound.

Adult↗
PubMed1997

The assessment of uterine and ovarian perfusion in infertile patients.

OBJECTIVE: To evaluate ovarian and uterine perfusion in 790 infertile patients. STUDY DESIGN: Transvaginal color Doppler assessment of the ovarian and uterine circulation in infertile patients with benign pelvic lesions, uterine anomalies and ovarian or uterine dysfunction. RESULTS: Uterine anomalies were detected in 146 patients: 135 septate and 11 bicornute uteri. No alteration, in terms of resistance index (RI), was detected for main uterine arteries in patients with duplication anomalies of the uterus. Submucous fibroids were identified in 25 patients, while subserous leiomyoma were diagnosed in five patients. The mean RI for these lesions covered the value of 0.55 +/- 0.09. Endometrial polyps altered the endometrial perfusion in 26 infertile patients (RI = 0.48 +/- 0.06), while 11 avascular intrauterine synechiae were identified. Functional ovarian cysts were transitory present in 59 patients. The RI varied from 0.52 +/- 0.06 for follicular and 0.46 +/- 0.08 for corpus luteum cysts. Ovarian endometrioma were visualized in 78 infertile patients. Forty eight of them were vascularized at the level of the hilus, while 16 showed pericistic vascular location (RI ranged from 0.40 to 0.59). Dermoid cysts (n = 12) were mostly avascularized (75%), while polycystic ovaries demonstrated increased intraovarian vascularity in all the examined cases. The mean RI detected within the ovarian stroma was 0.52 +/- 0.06. In 11 patients premature menopause was predicted due to low volume of the ovary (< 2 cm3) and absence of the intraovarian vascularity. Hydrosalpynx or sactosalpynx were imaged in 154 patients. The RI varied from 0.44 in acute to 0.74 in chronic stage of the disease. CONCLUSION: Transvaginal color Doppler allows precise estimation of the functional state of the reproductive organs in infertile patients.

Evaluation Studies as Topic↗
PubMed1997

The assessment of normal and abnormal luteal function by transvaginal color Doppler sonography.

OBJECTIVE: To evaluate intraovarian resistance index (RI) in 47 healthy fertile volunteers with ovulatory cycles, 28 patients with luteal phase defect (LPD) and four patients with luteinized unruptured follicle (LUF Sy). STUDY DESIGN: Transvaginal color Doppler assessment of the follicular and corpus luteum blood flow and plasma progesterone (P) levels were obtained in each patient. RESULTS: Significantly higher intraovarian artery RI (< 0.001) was obtained for LPD group than for controls during the luteal phase. In the control group both follicular and corpus luteum RI were significantly lower (P < 0.001) on the dominant side, while in LPD group no difference (P > 0.05) between the sides occurred. Mean P levels were significantly lower (P < 0.001) in the LPD group (6.9 +/- 2.3 ng/ml) than in controls (24.1 +/- 11.4 ng/ml). In all the LPD patients histopathology revealed delayed endometrial pattern, while normal endometrial dating was found in all the evaluated patients form the control group (n = 15). In the patients with LUF Sy (n = 4) similar RI values were obtained in the follicular and corpus luteum phase. There was no difference between the sides in terms of the intraovarian RI, while subnormal values of P were obtained in all the examined patients (14.1 +/- 6.2 ng/ml). CONCLUSIONS: Transvaginal color Doppler may predict the function capacity of the corpus luteum.

Corpus Luteum↗
PubMed1997

Detection and typing of human papillomaviruses by polymerase chain reaction in cervical scrapes of Croatian women with abnormal cytology.

The association between certain human papillomaviruses (HPV) and cervical intraepithelial neoplasia (CIN) is well documented, but still unknown among Croatian women. In 1995, women between the age of 17 and 64 with cytomorphologically abnormal smears (CIN I-IV) were tested for the presence of HPV. Consensus and specific primers were used in the polymerase chain reaction (PCR) to detect the most common types: 6, 11, 16, 18, 31 and 33, as well as the unknown-risk HPV types (HPV X). Out of 379 specimens, 163 (43%) contained one or more HPV types. Coinfection with different HPV types in the same sample was observed in 16 cases. Beside low-risk HPV 6/11 (25.8%) the most frequently observed types were high-risk HPV types 16 (20.2%) and 31 (17.8%). Globally, the HPV positivity rate declines with age. The presence of HPV DNA significantly increased from 35.5 to 61.1% along with the severity of the cervical intraepithelial neoplasia (CIN I-IV). HPV type 6/11 was strongly associated with CIN I (33.8%), HPV type 31 with CIN II (22.9%), and HPV type 16 with CIN III (50%).

Adolescent↗
PubMed1997

Luteal phase defect: comparison between Doppler velocimetry, histological and hormonal markers.

The aim of this prospective study was to investigate the relationship between the ultrasonographic appearance of the endometrium, histological dating by biopsy, hormonal profile and impedance within the segmental uterine and ovarian circulation for assessment of luteal phase function. A total of 61 infertile patients undergoing endometrial biopsy were studied by transvaginal B-mode and color and pulsed Doppler ultrasound. Uterine, radial, spiral, ovarian and intraovarian artery impedance throughout the natural ovarian cycle were related to histological and hormonal markers of uterine receptivity. Plasma levels of follicle stimulating hormone, luteinizing hormone (LH) and estradiol were measured on cycle days 5 and 10 and measurements were continued daily until the detection of the LH surge. Endometrial biopsy was performed 7 days after ultrasonically and hormonally detected ovulation. Progesterone levels were evaluated on the day of endometrial biopsy and 3 days later. After all the data were collected, the patients were divided into two groups, according to the histopathology: 15 patients with normal endometrial dating and 43 patients with a delayed endometrial pattern (i.e. luteal phase defect). One patient with an asynchronous endometrium and two anovulatory subjects were excluded from further evaluation. A significant difference between patients with a luteal phase defect and the control group was obtained for impedance in the uterine (p < 0.05), radial (p < 0.05), spiral (p < 0.001), ovarian (p < 0.05) and intraovarian arteries (p < 0.001) during the luteal phase. The endometrium showed secretory transformation when serum levels of progesterone were higher than 15 ng/ml. Segmental uterine and ovarian artery perfusion demonstrates a significant correlation with histological and hormonal markers of uterine receptivity. Therefore, blood flow impedance in the corpus luteum and spiral arteries may aid in assessing luteal phase adequacy.

Adult↗
PubMed1997

Conflicting data on intervillous circulation in early pregnancy.

According to classic embryological textbooks intervillous circulation is established early in the first trimester. This process starts with trophoblastic invasion of the decidua in which proteolytic enzymes facilitate the penetration and erosion of the adjacent maternal capillaries with formation of the lacunae. After the lacunar or previllous stage trophoblast invades deeper portions of endometrium with belonging spiral arteries. This gradual process finishes with direct opening of the spiral arteries in the intervillous space under the fully developed placenta. This classic concept of establishment of the intervillous circulation was challenged in 1987 and 1988 by the experiments of HUSTIN and SHAAPS. The authors believed that blood flow in the intervillous space is absent in incompletely development before 12 weeks of gestation. After the introduction of the new generation of far more sensitive color Doppler devices in the last few years, our group and several others reported a positive finding of intervillous circulation during the first trimester of pregnancy.

Chorionic Villi↗
PubMed1997

Intervillous circulation in all three trimesters of normal pregnancy assessed by color Doppler.

Our cross-sectional study included 115 healthy pregnant women in gestational age between 7 and 24 weeks. The aim of the study was to compare resistance (RI) and pulsatility (PI) indices, peak systolic velocity (PSV), end-diastolic velocity, and temporal averaged maximum velocity (TAMV) of the spiral arteries and vessels within the intervillous space in all three trimesters of pregnancy. The impedance to blood flow within the intervillous space significantly decreased towards the mid-pregnancy (p < 0.01) and then remained stable. Blood flow velocities within the intervillous space expressed by PSV, EDV and TAMV increased significantly (p < 0.01) towards the mid-pregnancy. After reaching the plateau between 16 and 22 weeks of gestation, these parameters remained almost constant until the 36th gestational week. Near the term low-significant decrease of blood flow velocities was noted: for PSV and TAMV p < 0.07, and for EDV p < 0.05. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward (28 +/- 12 vs. 36 +/- 12) until the 36th week of gestation (36 +/- 12 cm/s). The first report of the haemodynamic changes within the intervillous space during pregnancy may have implication in better understanding of the metabolical interchange between maternal and fetal side.

Chorionic Villi↗
PubMed1996

Doppler information pertaining to the intrapartum period.

The aim of the study was to evaluate the use of color-Doppler velocimetry during the labor. 325 intrapartal measurements of the umbilical artery, fetal aorta, middle cerebral artery and arcuate arteries were performed in a group of 105 patients. The resistance index (RI) and pulsatility index (PI) were measured. During the active labor the RI and PI of the umbilical artery remained unchanged. The impedance in arcuate arteries have increased (p < 0.05). The RI and PI of the middle cerebral artery showed non significantly increased mean values when compared with the corresponding values during pregnancy. But, a short term, transitory decreased impedance is registered during the decrement slope of contraction. Since fetal outcome was normal in all newborns, these changes are considered as physiologic.

Aorta↗
PubMed1996

[Polycystic ovary syndrome--Doppler parameters].

OBJECTIVE: To evaluate the value of transvaginal color and pulsed Doppler measurements of the uterine and ovarian arteries in infertile patients with polycystic ovarian syndrome (PCOS). STUDY DESIGN: Prospective controlled trial included forty (40) patients with PCOS and 40 healthy women. All the patients were examined by transvaginal color and pulsed Doppler on the 5th, 10th, 12th, 15th, 21st and 24th day of the menstrual cycle. The hormonal profile (estradiol (E2), luteinizing hormone (LH), follicular stimulating hormone (FSH), progesterone, testosterone and prolactin) was correlated to the Doppler results. RESULTS: The flow velocity patterns of uterine and ovarian vessels showed changes during the normal ovulatory menstrual cycle, while in the patients with PCOS these changes did not occur. The high resistance index (RI = 1.0) with reverse flow was detected in both ovarian arteries in PCOS group, and showed no cyclic changes. Ovarian stromal and hilar arterial impedance (0.54 +/- 0.05) as well as uterine artery resistance index (0.91 +/- 0.09) did not show significant changes during the menstrual cycle. CONCLUSIONS: Our study suggests that a large fraction of patients suffering from PCOS has elevated uterine artery resistance index despite normal plasma E2 levels. It can be postulated that excessive production of ovarian factor (other than E2) may increase the uterine resistance and alter the endometrial receptivity. This finding may explain why endometrial receptivity is shown to be poor in patients with PCOS. Estimation of uterine and ovarian arterial impedance values seems to have clinical impact in the management of these patients attending an in vitro fertilization program.

Adolescent↗