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Biomedical subjects

A Kurjak

Publications and source records attributed to A Kurjak.

At least 73 records · Page 4Linked to original sources
PubMed1995

Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography.

OBJECTIVE: To evaluate the role of transvaginal color Doppler in differentiating uterine sarcoma from myoma. STUDY DESIGN: A group of 2010 women were examined by transvaginal color Doppler ultrasonography 1 day before planned hysterectomy. Ten cases with uterine sarcoma were analyzed with respect to their color Doppler sonographic patterns and compared with 150 normal and 1850 myomatous uteri. Analysis of variance was used to test the significance among the subgroups. RESULTS: All cases of uterine sarcoma (100%) revealed abnormal tumoral blood vessels. The mean resistance index (RI) of these vessels was 0.37 +/- 0.03, ranging from 0.32 to 0.42, which is statistically significantly lower than that of the normal and myomatous (P < 0.001) uteri. There was no significant difference between RI in the right and left uterine arteries in each separate group; however, there was a decline in these values from normal, through myomatous, to sarcomatous uteri. Using a cutoff point of 0.40 for RI we were able to distinguish between benign and malignant myometrial tumors with a sensitivity of 90.91%, specificity of 99.82%, positive predictive value of 71.43%, and negative predictive value of 99.96%. CONCLUSION: Color Doppler sonography has the potential to distinguish uterine sarcoma from benign uterine lesions.

Adolescent↗
PubMed1995

The value of transvaginal color Doppler in the assessment of pelvic inflammatory disease.

This study compares transvaginal color and pulsed Doppler (TVCD), laparoscopic and clinical findings in 102 women with proven pelvic inflammatory disease (PID). Seventy-two (72) of them had acute symptoms, 11 presented with chronic pelvic pain and 19 patients were infertility cases suspected of tubal etiology. Uterine sonographic findings were demonstrated in 72 patients (70.6%). Free fluid in the cul-de-sac was demonstrated in 39 (38.2%) patients. Ovarian enlargement as the only finding was demonstrated in 6 (5.9%) patients, 22 (21.6%) presented with tubular adnexal structure, while in 74 (72.5%) patients it was of a complex nature. Color flow was obtained in all 6 patients presenting with ovarian enlargement, in 12 (54.5%) of those presenting with tubular adnexal structure, and in 56 (75.7%) of those with complex adnexal mass. Ovarian morphology was clearly delineated from adnexal mass in 59 patients (55.9%). The ipsilateral ovarian flow was altered in 50 of them (84.7%). The mean resistance index (RI) in patients with acute symptoms was 0.53 +/- 0.09 (+/-SD). It significantly differed from those obtained in patients with chronic pelvic pain (RI = 0.71 +/- 0.07) and infertility cases (RI = 0.73 +/- 0.09). We concluded that transvaginal color Doppler is useful additional tool in diagnosis and treatment monitoring in patients with PID.

Abdominal Pain↗
PubMed1995

Ovarian senescence and its significance on uterine and ovarian perfusion.

OBJECTIVE: To measure the flow velocity of the ovarian, uterine, radial, and spiral arteries in different age groups. DESIGN: Serial measurements throughout the menstrual cycle in normal cycling women with documented fertility were compared with those in postmenopausal patients with and without hormone replacement therapy (HRT). SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Two hundred fifty patients were analyzed: 120 healthy fertile women, 85 postmenopausal patients, and 45 postmenopausal patients receiving HRT. INTERVENTIONS: All patients were examined by transvaginal color and pulsed Doppler. MAIN OUTCOME MEASURE: Changes in the resistance index of flow velocity waveforms of the ovarian, uterine, radial, and spiral arteries. RESULTS: Ovarian artery Doppler measurements in postmenopausal patients showed a significant difference when compared with the ovarian artery on the side containing dominant follicle or corpus luteum in healthy fertile group. Uterine and radial artery flow velocity analyses demonstrated significant positive correlations between the resistance index and years of menopause. In patients receiving HRT, a lowering effect occurred in the resistance index of the main uterine artery and its intramyometrial branches. Visualization of clear Doppler signals from the spiral arteries was possible in 30% of women who were menopausal for < 5 years. Increased vascular impedance was the typical finding in this vessel for this group of patients. The addition of HRT resulted in higher visualization rates of the spiral arteries and lowered resistance index values. CONCLUSIONS: There are changes in the flow velocity patterns of the ovarian, uterine, radial, and spiral arteries with age. The fact that the uterine artery resistance index does not change significantly in the first postmenopausal years strongly supports the thesis that the aging process initially affects the uterus less than the ovary. Furthermore, the uterine environment can be manipulated more easily during the menopausal years by proper hormonal stimulation.

Aging↗
PubMed1995

Papers published by members of the Croatian Academy of Medical Sciences, registered in international bibliographic data bases in the period 1986-1990.

Scientific productivity of the CAMS members was analyzed according to the number of papers published in periodicals covered by international Medline and Science Citation Index data bases from 1986 to 1990. Results showed the mean scientific productivity per CAMS member, and the relationship between scientific productivity and age, field of medicine or respective biomedical discipline. The pattern of scientific productivity was also found to change, when analyzed according to Medline or SCI data bases in separate.

Bibliometrics↗
PubMed1994

Scoring system for prediction of ovarian endometriosis based on transvaginal color and pulsed Doppler sonography.

OBJECTIVE: To develop a new noninvasive scoring system using clinical signs and symptoms, CA-125 levels, sonographic findings, and transvaginal color and pulsed Doppler parameters for preoperative recognition of ovarian endometriosis. DESIGN: A 5-year prospective study in patients undergoing laparotomy and laparoscopy. SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Six hundred fifty-six benign and malignant adnexal masses, among which 103 were surgically proved to be ovarian endometriosis. INTERVENTIONS: All patients undergoing laparotomy and laparoscopy were examined by transvaginal ultrasonography with color Doppler imaging. Serum levels of CA-125 were measured the day before surgery. MAIN OUTCOME MEASURE: The total score was applied in all patients with adnexal masses. RESULTS: The scoring system proved to be very useful in distinguishing ovarian endometriosis from other benign and malignant ovarian lesions, with a sensitivity of 99.02% and a specificity of 99.64%, compared with morphological scoring system's sensitivity of 83.91% and specificity of 97.12%. CONCLUSION: The new noninvasive scoring system improves significantly the ability to discriminate between endometriosis and other benign and malignant ovarian entities.

Adult↗
PubMed1994

Vascularization of yolk sac and vitelline duct in normal pregnancies studied by transvaginal color and pulsed Doppler.

The yolk sac is an organ of increasingly recognized importance in the initial mechanisms of pregnancy maintenance and the early growth and welfare of the embryo. Having a complex protein secretion and an equally intricate ultrastructure, it is the primary source of blood and germ cells. This small and to date largely ignored structure may have a vital and interesting part to play in human embryonic development, which may be comparable to its proven evolutionary importance in other animals. The aim of our study was to assess the vascularity of the yolk sac and vitelline duct in 105 patients between the 6th and 10th weeks of gestation who were scheduled for termination of pregnancy for psychosocial reasons. The patients were divided in five subgroups depending on the duration of gestation. All of them had a normal developing pregnancy with no clinical symptoms of pathology (e.g. bleeding in early pregnancy). Gestational age was calculated from the first day of the last menstrual period and substantiated by crown-rump (CRL) measurements. After exploration of the gestational sac and embryo by transvaginal sonography, color Doppler was used to image the yolk sac and vitelline duct vascularity. The visualized vessels were analyzed with pulsed Doppler using the sample volume unit set of 1 mm. The assessment of obtained waveform signals was made by means of peak systolic Doppler shift (PSV) and pulsatility index (PI). The pulsatility index was calculated as a difference between peak systolic and end diastolic Doppler shift divided by the mean maximum velocity. At least 5 separate cardiac cycles were measured, and the mean value was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

Embryonic and Fetal Development↗
PubMed1994

Transvaginal color and pulsed Doppler study of uterine blood flow in the first and early second trimesters of pregnancy: normal versus abnormal.

Transvaginal color Doppler ultrasonography was used to study 131 normal early pregnancies, 30 molar pregnancies, 20 threatened abortions, two blighted ova, and five pregnancies with intramural myoma. Four separate parts of the maternal circulation were studied: uterine, arcuate, radial, and spiral arteries. There was statistical difference in the RI and PI among uterine, arcuate, radial, and spiral arteries (P < 0.001) in all observed groups of patients except those with intramural myoma. When the same part of the maternal circulation was compared among different groups of patients, the following results reached statistical significance: uterine artery in normal and molar pregnancy (P < 0.001); arcuate artery in normal and molar pregnancy (P < 0.001); radial artery in normal and molar pregnancy (P < 0.001) and in normal pregnancy and threatened abortion (P < 0.01); spiral artery in normal and molar pregnancy (P < 0.001), in normal pregnancy and threatened abortion (P < 0.01), and in molar pregnancy and threatened abortion (P < 0.01). The standard values of blood flow are different in normal and in some cases of abnormal early pregnancy (molar pregnancy, threatened abortion).

Abortion, Threatened↗
PubMed1994

Fetal choroid plexus vascularization assessed by color flow ultrasonography.

We investigated the development of intracranial vascularization in the human fetus, with particular emphasis on the choroid plexus. The fetal brain was visualized in 102 patients with healthy pregnancies between 9 and 16 weeks' gestation. Imaging was done transvaginally except in the pregnancies of longer duration with unfavorable fetal positions. Color flow imaging was used to identify vessels in the cranium and within the choroid plexus. Pulsed Doppler signals were obtained from an internal carotid-middle cerebral artery and from a choroid plexus vessel. The pulsatility index was calculated from the Doppler spectral envelope. A major cerebral vessel could be seen at 9 weeks' gestation. Choroid plexus vessels were first seen at 10 weeks 3 days. Visualization rates ranged from 35 to 75% for plexus vessels, and 65 to 100% for cerebral vessels. Visualization of choroid plexus vessels was maximal at 13 weeks. The pulsatility index for the cerebral arteries at this gestational period averaged 2.6 +/- 0.6. The result for the choroid plexus was 1.66 +/- 0.5. (P < 0.001). Visualization of the vessels of the choroid plexus increases and decreases as the gland develops and shrinks. This developmental period also is the time of active neurogenesis.

Adult↗
PubMed1994

Corpus luteum blood flow in normal and abnormal early pregnancy: evaluation with transvaginal color and pulsed Doppler sonography.

One hundred and thirteen (66.5%) women in this study had a normal intrauterine pregnancy with ages ranging 6 to 12 weeks of gestation. Fifty-seven (33.5%) patients were admitted to the hospital owing to clinically suspected abnormal early pregnancy. Dilatation and curettage were done on all women and tissue sample sent to the pathologist for a final diagnostic. Diagnosis of ectopic pregnancy was made on laparoscopy. Both ovaries were examined carefully by color Doppler in sonography in all patients. Color flow was used as a guide for pulsed Doppler exploration. Corpus luteum blood flow was defined as random, usually semilunar in appearance, dispersed vessels with very low impedance to blood flow. The resistive index and pulsatility index were calculated. Overall detection rate of corpus luteum blood flow in normal pregnancies was higher for the left ovary (62.6%) than for the right ovary (37.4%) (P < 0.01). The mean resistive and pulsatility indices from corpus luteum blood flow were not influenced by gestational age in normal pregnancy. The overall mean value for for resistive index was 0.452 +/- 0.04 and for pulsatility index 0.636 +/- 0.09. The overall detection rate of corpus luteum in abnormal pregnancies also was higher for the left ovary (56.7%) than for the right ovary (43.4%) (P < 0.01). The mean resistive indices from corpus luteum blood flow in patients with missed abortion was higher than in women with normal pregnancy (P < 0.01). Both resistive and pulsatility indices were higher in patients with incomplete or threatened abortion in comparison with normal pregnancy (P < 0.01). No statistically significant difference was seen in the case of anembryonic, molar, or ectopic pregnancy.

Adult↗
PubMed1994

An attempt to screen asymptomatic women for ovarian and endometrial cancer with transvaginal color and pulsed Doppler sonography.

Several screening procedures have been proposed to detect ovarian and endometrial cancer. However, none of them is sensitive and specific enough to be used in population-based screening programs. During our 5 year long study, 5013 asymptomatic women (44% premenopausal and 56% postmenopausal women) were scanned by transvaginal color and pulsed Doppler ultrasonography in an attempt to detect malignancy. These women had 404 adnexal cysts; 70 had resolved spontaneously on follow-up scans and 18 persisted. Another 316 sonographically benign cysts are still in the procedure of follow-up second scans. Of 5013 women, four women had stage I ovarian carcinoma and six had stage I endometrial carcinoma. There was one false-positive case encountered with an endometrioma. Only 14 women were subjected to major operative intervention; others underwent minor procedures based on the benign scan findings. No medical or surgical complications were reported. Transvaginal color Doppler ultrasonography, a noninvasive procedure, can detect ovarian and endometrial carcinoma in asymptomatic women and may be used as a screening procedure for these diseases.

Endometrial Neoplasms↗
PubMed1994

The fetus as a patient.

This article highlights the concept, history and development of fetal medicine. The first attempts of fetal medicine date from the stone age and have continued throughout the medieval and modern ages. Attempts to influence fetal health and pregnancy outcome at first were purely theoretical and passive, limited by ignorance, fear, and religion. With the development of the medical sciences, the role of the obstetrician became more active. Today, not only obstetricians, but many other experts in the field of antenatal care as well, deal with the great number of medical and technological advances. The limitations arising today are mainly ethical. The main question that still has not been answered is to what extent the physician is allowed to interfere with the process of fetal development and pathology, based upon real fetal and maternal benefit. In order to answer this question and to coordinate many activities by different experts in this field, an international society antitled The Fetus as a Patient was formed in 1985. Croatian experts have played a leading role in this concept.

Ethics, Medical↗
PubMed1994

Transvaginal color Doppler in early pregnancy: rational and clinical potential.

Remarkable hemodynamics changes that occur in the maternal circulation, the continuous growth and development of the feto-placental circulation is now studied by transvaginal Doppler. This seems to give more light in understanding of the early pregnancy pathophysiology. For the first time, it seems that ultrasound might be able to distinguish different forms of gestational trophoblastic disease. Due to its non-invasiveness and relatively simple and easily performed technique, transvaginal color Doppler might be of considerable clinical value. The other important point is that study results are available immediately for clinical judgement. From our study, we can conclude that transvaginal ultrasound with color and pulsed Doppler is potentially valuable diagnostic tool to differentiate forms of the gestational trophoblastic diseases. On the basis of Doppler findings, the complete mole can be reliably distinguish from the invasive mole or choriocarcinoma. The degree of myometrial invasion can be also assessed. This can be an objective foundation for therapeutical approach. There is no doubt that studies of maternal-fetal circulation in early pregnancy may help for better understanding of physiological and pathophysiological hemodynamic changes. Investigation of maternal (main uterine, arcuate, radial and spiral) arteries; placental (umbilical, chorionic arterioles) vessels and fetal (aorta and intracranial circulation) arteries flow patterns may help in order to diagnose abnormal implantation. More studies are necessary in order the Doppler technique to be used for clinical judgment in early pregnancy. Safety aspects should also be considered. However, potentials of these technique are more then obvious.

Corpus Luteum↗
PubMed1994

Doppler ultrasound in all three trimesters of pregnancy.

Doppler ultrasound velocimetry of uteroplacental, umbilical, and fetal vessels provides the clinician with important information on the hemodynamics of the vascular area under study. Transvaginal color Doppler is a new technique that allows precise investigation of fetomaternal circulation in early pregnancy. Doppler can be used to follow physiologic hemodynamic changes in uteroplacental and fetal vessels in this period of gestation, and to measure circulatory disturbances in some pathologic conditions. In late pregnancy, Doppler is a useful diagnostic tool for monitoring fetuses with intrauterine growth retardation. Doppler is a better predictor of perinatal morbidity than other methods of fetal surveillance. Recent investigations have shown that fetal vein flow affects fetal wellbeing. Randomized control trials have given different answers about the cost-effectiveness of Doppler in obstetrics.

Female↗