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Biomedical subjects

A Kurjak

Publications and source records attributed to A Kurjak.

At least 127 records · Page 7Linked to original sources
PubMed1991

Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy.

Transvaginal color Doppler was used to investigate the uteroplacental circulation of 45 patients with normal intrauterine pregnancies at 4-18 weeks' gestation. The main uterine artery and the radial and spiral arteries were demonstrated, and characteristic flow velocity waveforms were obtained in more than 90% of cases. The indices of impedance to flow decreased with gestation and there was a progressive fall in these indices from the uterine artery, through the radial, to the spiral artery. Blood velocity in the uterine artery increased exponentially with gestation.

Adult↗
PubMed1990

Transvaginal color Doppler imaging.

Transvaginal color Doppler was used to assess circulation in pelvic vessels in a group of 64 patients including 15 patients with fertility problems, 18 patients with pelvic tumors, 2 cases of suspected ectopic pregnancy, and 29 pregnant patients with fetuses between 6 weeks and 10 weeks, menstrual age. Blood flow was successfully displayed by color Doppler in the external and internal iliac arteries, and the uterine arteries, but flow in ovarian arteries could not be visualized. In the subgroup of patients with pelvic tumors, neovascularization of tumor tissue was documented in 6 out of 10 cases of uterine fibroma and in 2 cases of ovarian cancer. In 6 cases involving benign ovarian pathology, no abnormal blood supply was observed. A comparison between the characteristics of blood flow within uterine fibromas and ovarian malignancies showed lower impedance and higher blood velocity in cases of malignancy. In early pregnancy blood flow in the umbilical artery could be visualized by color Doppler starting from the 6th week and flow in the aorta from the 8th week. Flow in the trophoblasts was observed with an overall success rate of 59% and successfully demonstrated in 1 out of 2 cases of ectopic pregnancy.

Blood Flow Velocity↗
PubMed1990

The assessment of abnormal pelvic blood flow by transvaginal color and pulsed Doppler.

Transvaginal color Doppler was used to analyze a group of 19 healthy, 48 infertile and 8 postmenopausal women; 67 patients with uterine and 151 patients with adnexal masses, and 19 patients with a suspected ectopic pregnancy. The ultrasonographer had not been informed of other clinical findings and indications for operative treatment. A 5 MHz transvaginal color Doppler probe was used to visualize the pelvic anatomy and blood flow. Each arterial blood flow velocity was classified into either of two types. In the normal flow pattern, the diastolic flow component was absent or small and the value of resistance index (RI) was greater than 0.50. In the abnormal flow pattern, a large diastolic flow component was evident and the value of RI was less than 0.50. Transvaginal color and pulsed Doppler studies in confirmed malignant uterine masses had moderate accuracy (90.2%), with a sensitivity (55.6%) and specificity (100%); and in confirmed malignant adnexal masses high accuracy (100%), sensitivity (100%) and specificity (100%). Comparison of blood flow characteristics within benign and malignant tumor tissue revealed less impedance and higher velocity in cases of malignancy. Blood flow studies in both uterine arterias have not shown clinically important values. This method can be also used in the diagnosis of ectopic pregnancy.

Blood Flow Velocity↗
PubMed1990

[Transvaginal color Doppler for evaluating gynecologic pathology of the pelvis].

Transvaginal colour Doppler Sonography was used to assess circulation in pelvic vessels in a group of 611 non-pregnant and 88 pregnant patients. A 5 MHz transvaginal probe was used to visualize the pelvic anatomy and blood flow. Further analysis was made by pulsed Doppler where flow velocity waveforms were recorded and analysed by calculation of resistance index (RI). In the normal flow pattern, the diastolic flow component was absent or small and the value of RI was greater than 0.50. In the abnormal flow pattern, the large diastolic flow component was evident and the value of RI was less than 0.50. The transvaginal colour Doppler assessment of tumour vascularity can be used for better non-invasive characterisation of adnexal tumour and may be potentially useful as a screening test for ovarian malignancy. Because of its high sensitivity, specificity and accuracy, transvaginal colour Doppler Sonography is the imaging of choice, in diagnostic procedure of early pregnancy failure and ectopic pregnancy. The guidance of a pulsed Doppler beam by colour flow mapping helps to locate areas of the most abundant flow and makes examination more reproducible, faster and easier.

Abortion, Induced↗
PubMed1990

Is there an association between fetal viral infection and fetal malformation? I. Detection of specific IgM antibodies in the serum of malformed fetuses.

Determinations of IgG and IgM antibodies specific for cytomegalovirus (CMV), herpes simplex virus (HSV1), herpes simplex virus (HSV2), varicella-zoster virus (VZV), rubella, echo, Coxsackie and morbilli viruses were performed in 20 sera from malformed fetuses. Demonstration of a fetal infection by increased fetal serum IgM permits linkage to a detected fetal malformation. In parallel, 14 maternal sera and 17 amniotic fluid samples were examined. Laser nephelometry (a quantitative method) was used for the determination of IgM and IgG class immunoglobulins. None of the fetal sera were found to contain IgM class antibodies specific for the viral antigens studies. While IgM CMV-specific antibodies were present in one maternal serum, the specific IgM was absent in the fetus. The absence of specific IgM antibodies appears to warrant the conclusion that the malformed fetuses were uninfected by any of the above viruses. IgM antibodies were detected in two fetal sera by quantitative methods. The IgM antibodies present in two fetuses probably were generated in response to some other introduced antigen.

Antibodies, Viral↗
PubMed1990

Transvaginal colour Doppler ultrasound in normal and abnormal early pregnancy.

The value of transvaginal colour and pulse wave Doppler in the diagnosis of pathologic early intrauterine and tubal pregnancy was assessed. Forty-one normal pregnancies, 6 blighted ovum, 6 missed abortions, and 22 suspected ectopic pregnancies (13 proven tubal pregnancies) were examined. Single 5 MHz transvaginal colour and pulse wave Doppler probe was used and once clear signals from uterine vessels, umbilical artery or trophoblastic vessels were obtained. Resistance Index (peak systole--end diastole/peak systole, RI) from the corresponding waveforms was calculated. In 41 normal pregnancies (examined before termination of pregnancy) with gestational age ranged from 6 to 10 weeks mean RI in uterine artery was 0.81 (SD 0.06), in the umbilical artery 1 (SD 0), and 0.48 (0.08) in the trophoblastic vessels. Mean RI from uterine arteries in six pregnancies with blighted ovum and six with missed abortion were 0.77 (SD 0.11) and 0.69 (SD 0.13) respectively. In 2 out of 6 cases of blighted ovum and 4 out of 6 cases of missed abortion flow in trophoblastic vessels could not be detected. These findings suggest ineffective early placentation in pathologic pregnancy. Twenty-two patients with suspected ectopic pregnancy (raised serum beta HCG with empty uterus, amenorrhoea with abdominal pain and/or palpable abdominal mass) were examined. In 13 cases tubal pregnancy was confirmed by laparoscopy and/or laparotomy. In the remaining nine cases the diagnosis was excluded by means of laparoscopy or subsequent negative beta HCG. Doppler diagnosis of ectopic pregnancy was made when colour flow in adnexa with RI less than 0.56 was revealed.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Missed↗
PubMed1990

The assessment of luteal blood flow in pregnant and non-pregnant women by transvaginal color Doppler.

Transvaginal color Doppler of luteal flow was performed on 58 patients with normal early pregnancy before artificial abortion, 73 patients with proven ectopic pregnancy and 75 non-gravid patients in luteal part of menstrual cycle. The equipment used were Aloka Color Doppler SSD-350 and SSD-680 with a 5 MHz transvaginal probe. Obtained color flow from ovarian tissue was explored with pulsed Doppler and the Pourcelot resistance index was calculated. Typical luteal low-impedance flow was detected in 82.8% cases of early pregnancy, 80.8% cases of ectopic pregnancy and 69.3% cases of non-pregnant women. The lowest resistance index (RI = 0.42 +/- 9.12) of luteal flow was found in cases of non-pregnant women, and the highest resistance index (RI = 0.53 +/- 0.09) was obtained in cases of early normotopic pregnancy. RI in cases of ectopic pregnancy was 0.48 +/- 0.07. Statistical analysis has shown significantly different RI in each of 3 groups of patients (P greater than 0.001). Corpus luteum was seen as early as a few days after ovulation in non-pregnant women and was present until about the 11th week of amenorrhea in pregnant women. In 86.4% patients with proven ectopic pregnancy, luteal flow was detected on the same side as the ectopic pregnancy. Our results have shown different RI value of corpus luteum flow in different groups of patients. Such findings could help to exclude pregnancy, specially with non-specific B-mode ultrasound features. Corpus luteum flow could be used as a guide for searching for ectopic pregnancy.

Corpus Luteum↗
PubMed1990

Ultrasonic diagnosis and perinatal management of complicated and uncomplicated fetal ovarian cysts: a collaborative study.

Ovarian cysts can be demonstrated in the ovaries of fetuses and full term infants at birth. Small cysts involute spontaneously during fetal life or within the first few months of life. Large cysts may cause mechanical complications or respiratory distress. Sonographic detection of fetal ovarian cysts has been reported, as well as intrauterine surgical treatment. The sonographic findings and the outcome of the smaller and the complicated cysts were studied in 25 pregnant women. Uncomplicated fetal ovarian cysts should be monitored by weekly examination until delivery. Huge ovarian cysts may be an indication for cesarean section; or, intrauterine aspiration may be the alternative. Complicated fetal ovarian cysts represent an indication for neonatal surgery.

Female↗
PubMed1990

Tissue characterization by transvaginal colour Doppler for the evaluation of gynaecological tumours. 1. Review of the literature.

This is the first review published in Hungary about the usefulness of transvaginal colour Doppler (TVCD) in gynaecology. The history of "ultrasound tissue characterization", the conventional and colour Doppler methods are discussed as well as the pathomorphological basis of abnormal Doppler signals. The summary of tumourangiogenesis, of neovascularization and its manifestation in Doppler spectrum are given. The differences between normal and pathological Doppler signals in female small pelvis are shown. It is concluded that the routine application of TVCD will reduce the rate of false positive results and "luxury" operations from screening procedures.

Female↗
PubMed1990

Tissue characterization by transvaginal colour Doppler for the evaluation of gynaecological tumours. 2. Clinical experiences.

Transvaginal colour Doppler was used to evaluate the blood flow patterns in pelvic vessels in a group of 315 patients including 168 with uterine tumours and 147 with adnexal masses. Neovascularization of malignant tumour tissue was successfully displayed by colour Doppler in the vases of endometrial and ovarian cancers but no abnormal blood supply was observed in the cases of early cervical cancers. A comparison between the characteristics of blood flow within benign and malignant lesions showed lower resistance index in cases of malignancy. The sensitivity, specifity, positive predictive value, negative predictive value and the diagnostic accuracy of this new method in the recognition of endometrial and ovarian cancers are higher than 95%. By the help of transvaginal colour Doppler (together with the classical methods as colposcopy, cytology etc.) it will be possible to establish of complex screening programmes for all types of gynaecological cancers.

Adnexal Diseases↗
PubMed1990

Conventional B-mode and transvaginal color Doppler in ultrasound assessment of ectopic pregnancy.

The study was arranged in two parts. In the first part, 43 of the clinically suspected ectopic pregnancies were sent for a transvaginal color Doppler examination. Both cystic and complex adnexal masses were carefully scanned for their Doppler flow characteristics. The Pourcelot index (RI) was calculated and the RI 0.40 was used as a cut-off point to differentiate the trophoblastic (RI less than 0.40) and the normal blood flow (RI greater than 0.40). The diagnosis was confirmed by the beta hCG serum test. Three false-negative and one false-positive findings were obtained. The transvaginal color and pulsed Doppler study of the flow within ectopic pregnancy has a high degree of sensitivity (87.5%), specificity (94.7%) and accuracy (90.7%). Pelvic sonograms of another 110 patients with proven ectopic pregnancy were reviewed retrospectively. The ectopic gestational sac with the alive embryo was documented in 11.8% cases and without the embryo in 30.4% cases. A mixed, solid or cystic adnexal mass was detected in 57.8% patients. Intrauterine findings showed a pseudogestational sac in 13.6% cases, a cluster configuration in 18.6% cases and a linear configuration in 67.8% cases. Criteria for the ultrasound diagnosis of ectopic pregnancy influencing its specificity, sensitivity and accuracy are discussed.

Female↗
PubMed1989

Ultrasound diagnosis and evaluation of fetal tumors.

Fetal tumors represent a rare and heterogeneous group of abnormalities. A significant proportion of them can now be diagnosed by using modern high resolution ultrasonic equipment. During 15 years there were 57 fetal tumours detected prenatally. Hygroma colli is the most frequent fetal tumor. It should be emphasized that cystic hygroma generally carries poor prognosis, and after an early diagnosis, termination of pregnancy is most logical approach. Contrary to the general opinion our own experience showed that there are cases in which prognosis could be much better as illustrated with our 4 cases. All of the treated fetuses, after surgical resection, had normal development and are now on the age of 5, 4, 3 and 2 years of life. An ovarian cyst can be suspected if a fluid-filled structure is visualized next to a fetal kidney and female external genitalia are recognizable. The ultrasound finding suggestive of an ovarian cyst is that of a pelvic cystic or complex mass in a female fetus with normal kidneys and urinary bladder and a normal gastrointestinal tract. In most cases, the normal course of fetal ovarian cyst is a spontaneous intrauterine or postnatal involution. Prenatal diagnosis improves neonatal outcome by allowing an appropriate choice of the optimal time, mode and place of delivery in order to avoid accidental and unexpected intrapartum and postnatal complications. The management of a fetus affected by an ovarian cyst depends on the size and on the echo-pattern of the cyst. It remains unclear whether in utero puncture of the cyst and evacuation of its content should be justified in cases of particularly large ovarian cyst. In our opinion intrauterine procedure can be attempted in the presence of large cyst fulfilling the fetal abdomen. We have treated actively two cases of large ovarian cysts by ultrasonically guided puncture before delivery and both fetuses underwent surgery later without complications. If properly performed puncture of the cyst seems to be a low risk procedure in comparison to potential problems that cyst may cause to the fetus or by causing dystocia. Sacrococcygeal teratoma represents the most frequent tumor in the fetuses and newborns. Prenatal diagnosis is usually simple and based on the visualization of tumor of variable size and internal structure. Tumors may appear as completely cystic, mixed or predominantly solid with obvious calcifications. Cystic and calcified tumors are most likely to be benign. Obstetrical management of sacrococcygeal teratoma depends on numerous parameters which include size and texture of the tumor, and gestational age.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1989

Transvaginal color Doppler for the assessment of pelvic circulation.

Transvaginal color Doppler was used to analyse a group of 56 patients including 41 with proven pelvic masses and 15 infertility patients with normal pelvic anatomy. All patients were examined by ultrasound before laparoscopy or/and laparotomy. The ultrasonographer had not been informed of other clinical findings and indications for operative treatment. Comparison of blood flow characteristics within uterine fibromas and ovarian malignancies revealed less impedance and higher blood velocity in cases of malignancy. When predicting the malignant nature of pelvic tumors, no false-negative results were encountered, and only one false positive diagnosis of malignancy.

Color↗
PubMed1989

[Prenatal diagnosis of hereditary epidermolysis bullosa using ultrasonically guided biopsy of the fetal skin].

Ultrasonically guided fetal skin biopsy was performed in 5 patients who were at risk having a baby affected by epidermolysis bullosa hereditaria. Samples of the fetal skin were taken by means of Tru-cut biopsy needle that was introduced transabdominally into the amniotic cavity under continuous ultrasound control. Samples of the skin were obtained in all cases and were adequate for histopathological analysis. There were no significant clinical complications that may be related to the procedure. Prenatal diagnosis of the disease was made in 2 cases. In both cases pregnancies were interrupted. In 3 cases with normal histologic findings pregnancies resulted in term deliveries of normal babies. The authors suggest that fetal skin biopsy can be successfully performed under sonographic guidance. This diagnostic procedure may be considered the method of choice for prenatal diagnosis of hereditary skin disease.

Biopsy, Needle↗
PubMed1989

Contribution to the recognition of iniencephaly on the basis of a new case.

A child at term had been delivered by means of Caesarean operation because of its I. dorso-superior transverse position. The not viable, female newborn had a malformation causing an extremely retroflexion of the head. After intensive pathological and anatomical study the main diagnosis was iniencephaly and heart malformation. A large number of further results, also of malformated brain anatomy is given to contribute to the knowledge of the malformation sequence. The chances for early detection of the malformation are discussed.

Abnormalities, Multiple↗
PubMed1989

[The ethics of prenatal diagnosis and therapy].

Present ability to diagnose and treat fetal birth defects has achieved considerable sophistication. However, new scientific knowledge and resultant technologies create complex ethical dilemmas for society. Society has a critical stake both in the successful treatment of fetal disorders and in the maintenance of respect for the human dignity of the fetus. Therefore, prenatal diagnosis and therapy raises not only scientific issues but also ethical and legal ones which challenge many of our traditional concepts of the fetus. Undoubtedly, there is a need for involvement of not only individual patients but also society as a whole in setting rules and priorities for fetal therapy. In the meantime, the responsibility of those undertaking fetal therapy includes an obligation to report to the medical profession all results, good or bad, so that the merits and liabilities of fetal treatment can be established as soon as possible.

Congenital Abnormalities↗