US case of the day. Right-sided interstitial (cornual) ectopic pregnancy.
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Adult↗
Biomedical subjects
E A Lyons
Publications and source records attributed to E A Lyons.
US case of the day. Hydatid cyst (Echinococcus granulosus) in the right lobe of the liver.
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Adult↗
Diagnostic imaging management in Manitoba: 1995-2000.
As part of a 5-year imaging management plan being developed for the single insurance carrier in Manitoba, the radiologic utilization for the province was reviewed. For the fiscal year 1993 (April 1, 1992, through March 31, 1993), 1,056,694 imaging studies were performed in a total patient population of 1,133,117 in 81 hospitals and 39 offices in which 648 units of equipment were operated by 773.4 full-time personnel at a cost of $100,302,812 ($75,227,109 in U.S. dollars). The skin dose for the total population for the year was 40,112 Gy, compared with 35,513 Gy in 1979. Since 1979, there has been a 9% increase in the number of radiologic examinations (from 972,426 examinations), a greater need for more personnel to conduct ultrasound, mammography, computed tomography, and magnetic resonance imaging examinations, and striking costs escalation (from $25,082,500 to $100,302,812). Reduction of total funding for imaging services will be possible only if the medical service infrastructure and physician behavior are altered, since imaging is a support service. Hospital services must be integrated and the infrastructure reduced, and physicians must adhere to guidelines and practice protocols for requesting consultations.
Health Care Costs↗
Decidual cyst: endovaginal sonographic sign of ectopic pregnancy.
PURPOSE: To determine the prevalence of decidual cysts in patients with ectopic pregnancy and assess the value of endovaginal sonographic demonstration of decidual cysts in predicting ectopic pregnancy. MATERIALS AND METHODS: A series of 288 proved ectopic pregnancies was reviewed, and a series of 179 patients with pregnancies of less than 8 weeks menstrual age was prospectively examined. RESULTS: Decidual cysts were identified in 30 (14.4%) of 208 ectopic pregnancies. In 12 patients a decidual cyst was the first sonographic sign of ectopic pregnancy, and in six patients it was the only abnormal sonographic finding. Four of five patients with decidual cysts had an ectopic pregnancy. Decidual cysts had a sensitivity of 21%, specificity of 92%, positive predictive value of 80%, and negative predictive value of 42% in the diagnosis of ectopic pregnancy. CONCLUSION: Patients with decidual cysts are at high risk for ectopic pregnancy and should be monitored or treated appropriately, depending on the clinical findings.
Adult↗
First-trimester umbilical cord cysts.
Cystic masses of the umbilical cord have been detected in the 2nd and 3rd trimesters of pregnancy in association with fetal abdominal wall defects and chromosomal anomalies. With high-resolution endovaginal ultrasound (US), umbilical cord cysts can be visualized during the 1st trimester. Their origin and significance must be considered for proper obstetric management. The authors report eight cases in which cystic masses of the umbilical cord were detected during US examinations performed at 8-9 weeks menstrual age. In the five cases followed to term, both the infant and the umbilical cord were found to be normal at physical examination. Sonographically, all cysts appeared to be eccentric in relation to the umbilical cord, and, although all were closer to the fetus, the cysts were clearly extraembryonic. Cyst size was 2.0-7.5 mm (mean, 5.2 mm). Seven cysts resolved by 12 weeks menstrual age. The incidence of cysts in patients who underwent US at the authors' institution between 8 and 12 weeks menstrual age was 0.4%; the true frequency is unknown without routine 1st-trimester scanning of all patients.
Cysts↗
Yolk sac diameter and shape at endovaginal US: predictors of pregnancy outcome in the first trimester.
Four hundred eighty-six consecutive women who underwent endovaginal sonography when their fetuses were less than 10 weeks menstrual age (MA) were evaluated to establish the normal size and shape of the secondary yolk sac (YS) and to assess the value of YS measurement in predicting pregnancy outcome in the first trimester. A YS diameter more than two standard deviations (SDs) above the mean when compared with the mean gestational sac diameter allowed prediction of an abnormal pregnancy outcome with a sensitivity of 15.6%, a specificity of 97.4%, and a positive predictive value of 60.0%. A YS diameter more than two SDs below the mean allowed prediction of an abnormal outcome with a sensitivity of 15.6%, a specificity of 95.3%, and a positive predictive value of 44.4%. No pregnancy with a normal outcome had a YS diameter of greater than 5.6 mm at less than 10 weeks MA. In six patients, the YS diameter was greater than 5.6 mm. All six had an abnormal outcome. Of seven patients with abnormal YS shape at initial sonography, three had abnormal YS shape at follow-up examinations. All three had an abnormal outcome.
Abortion, Spontaneous↗
Endovaginal and translabial ultrasound in pregnancy.
Endovaginal sonography provides earlier and enhanced visualization of the gestational sac and its contents than does transvesical sonography. This paper discusses the role of endovaginal sonography in common first trimester diagnostic problems, including pregnancy dating, first trimester pregnancy loss, ectopic pregnancy, and early diagnosis of fetal anomalies, and reviews the use of endovaginal color flow Doppler in the diagnosis of ectopic pregnancy. A brief discussion of the role of endovaginal and translabial sonography in the second and third trimesters is included.
Female↗
Transvaginal sonography of normal pelvic anatomy.
The major structures of interest in the pelvis for sonography are the uterus and ovaries. TVS, with its superior imaging characteristics, provides better sonographic detail of this anatomy and improves our diagnostic capabilities. It is certainly reasonable to expect this approach to yield even greater improvements in the future as the refinements to the technology continue to evolve.
Female↗
Noninvasive diagnosis of resistant ovary syndrome by ultrasonography.
OBJECTIVE: To compare transvaginal ultrasonographic features of the ovaries and endometrium of patients with premature ovarian failure to normally cycling women on oral contraceptives (OCs), menopausal women with an equivalent duration of amenorrhea to the premature ovarian failure group, and patients with Turner's syndrome. DESIGN: Transvaginal ultrasonography in groups of women with premature ovarian failure, OC, and menopause. SETTING: All subjects were studied in an academic tertiary care center. PATIENTS/PARTICIPANTS: Seventeen women with premature ovarian failure, 20 volunteers on OC, 20 with menopause, and 4 patients with Turner's syndrome were studied. INTERVENTION: None, except for OCs in the OC group only. MAIN OUTCOME MEASURES: Frequency of ovarian, ovarian follicle, and endometrial visualization and their respective measurement in the three groups. RESULTS: At least one ovary was visualized in 84% of the premature ovarian failure patients as compared with 95% of the OC and menopause groups and 25% of the Turner patients. Mean ovarian volume was smaller in the premature ovarian failure group as compared with the OC group but equal to that of the menopause group. In the premature ovarian failure group, 41% had follicles in their ovaries as compared with 95% in the OC group, 5% in the menopause group, and none in the Turner group. The number of follicles per ovary was significantly lower in the premature ovarian failure as compared with the OC group, whereas only one subject had a single follicle in the menopause group. Premature ovarian failure subjects with follicles had larger ovaries than those without follicles. Endometrial thickness was not different among the groups. CONCLUSION: Ultrasonography may serve to identify a substantial subset (approximately 40%) of premature ovarian failure patients with ovarian follicles and potential for fertility consistent with the diagnosis of resistant ovary syndrome.
Adult↗
The potential use of expert systems to enable physicians to order more cost-effective diagnostic imaging examinations.
Educating physicians to order diagnostic imaging examinations more cost-effectively is a difficult and time consuming task, which may be assisted significantly by the use of an expert system. This report is based on a study undertaken at the Health Sciences Centre in Winnipeg, Manitoba, to determine the feasibility of implementing an expert system to aid physicians in selecting appropriate imaging studies. The report reviews the potential benefits, requirements, and limitations of expert systems under development, and highlights the major issues to be considered in choosing such a system for implementation. An extensive literature search was done and is included to aid the reader interested in pursuing this opportunity for improving the cost-effective utilization of expensive diagnostic imaging resources.
Computer-Assisted Instruction↗
Characterization of subendometrial myometrial contractions throughout the menstrual cycle in normal fertile women.
The objective was to study the characteristics of ultrasonographically detected subendometrial myometrial contractions. The contractions were evaluated by 328 ultrasound scans throughout the menstrual cycle. Reproducibility of these findings were studied in consecutive cycles. Eighteen healthy ovulatory volunteers with proven fertility were evaluated for at least one complete menstrual cycle in the follicular, periovulatory, and luteal phases. Multiple cycles were studied in 10 volunteers. The results showed that the contractions increase in frequency, amplitude, and percentage toward the fundus throughout the follicular and periovulatory phases. The pattern is essentially reversed in the luteal phase. There is reproducibility of these patterns from cycle to cycle. We conclude that there is a definite identifiable pattern of subendometrial myometrial contractility that varies with the phases of the normal menstrual cycle and recurs in a similar fashion from cycle to cycle.
Adult↗
Endovaginal sonographic diagnosis of ectopic twin gestation.
Endovaginal sonography has permitted earlier diagnosis of ectopic pregnancy. Twin ectopic pregnancy is rare. Until now, antenatal diagnosis of twin ectopic pregnancy using endovaginal sonography had not been reported. Three cases of twin ectopic pregnancy diagnosed via the intracavitary probe are presented.
Adult↗
Normal pelvic anatomy using transvaginal scanning.
The fine spatial and contrast resolution accorded by TVS provides us with the opportunity to see the uterus, ovary, and larger pelvic vessels with detail and accuracy. Other structures may also be visualized but not with the same finesse, regularity, or attention. Transvaginal color Doppler imaging and pulsed waveform analysis capabilities now provide us with the opportunity of distinguishing vascular and nonvascular structures, and gives us the ability to determine the normal and abnormal flow characteristics of pelvic viscera. Improvements in TVS technology will undoubtedly expand our future capabilities and applications.
Female↗
Contractions of the inner third of the myometrium.
Forty-six consecutive endovaginal ultrasound examinations were screened for the presence of myometrial contractions. The study group contained pregnant women up to 10 weeks' menstrual age, nonpregnant, and postmenopausal women. Rhythmic myometrial contractions of the inner myometrial third not previously reported were seen in 35 studies in pregnant, nonpregnant, and postmenopausal women. The contractions involved the inner third of the myometrium in all but two cases. In these two cases, all three muscular layers were involved. The majority of women showed retrograde contractions, with the contraction wave moving from the cervix to the fundus. In menstruating women and one case of abortion, the contractions were antegrade. It is our speculation that these retrograde contractions of the inner myometrial third may be important in sperm transport and for the conservation of early pregnancies within the uterine cavity.
Adult↗
Endovaginal US: demonstration of cardiac activity in embryos of less than 5.0 mm in crown-rump length.
The authors reviewed the endovaginal ultrasonographic (US) findings for 96 patients with embryos with crown-rump lengths of less than 5.0 mm. Of the 71 patients with adequate follow-up, initial endovaginal US demonstrated cardiac activity in 46 embryos and no cardiac activity in 25. Initial endovaginal US failed to demonstrate cardiac activity in five of 40 normal embryos, three with crown-rump lengths of less than 2.0 mm and two, between 2.0 and 3.9 mm. Endovaginal US identified cardiac activity in all 12 normal embryos with crown-rump lengths of 4.0-4.9 mm. The presence of cardiac activity was associated with a 24% risk of spontaneous abortion. In embryos between 2.0 and 4.9 mm in crown-rump length, absent cardiac activity was associated with a 91% risk of abortion. All 17 patients with vaginal bleeding and embryos demonstrating no cardiac activity subsequently aborted. The embryonic yolk sac was absent in 35% of patients who subsequently aborted. Variation outside of the 95% confidence limits of the mean for crown-rump length compared with mean gestational sac diameter and yolk sac diameter was also helpful in predicting an abnormal outcome. Nonvisualization of cardiac activity at endovaginal US in embryos less than 4.0 mm in crown-rump length may be normal and warrants follow-up US examination.
Abortion, Spontaneous↗
Ultrasound in the first trimester of pregnancy.
High-resolution sonography, including transvesical and endovaginal techniques, has resulted in enhanced visualization of embryonic and extraembryonic structures. With endovaginal sonography, the gestational sac may be seen within the decidua at about 4.5 weeks menstrual age. The yolk sac is the first structure to be seen within the gestational sac, and confirms the presence of a gestational sac rather than a decidual cast. The embryo is identified by endovaginal sonography early in the 6th week, and cardiac activity is routinely identified by a crown-rump length of 3 to 5 mm. On endovaginal sonography, absent cardiac activity in an embryo having a crown-rump length of greater than 3 to 5 mm indicates embryonic death. With endovaginal scanning, a gestational sac of greater than 8 mm without a yolk sac, or greater than 16 mm without an embryo, also indicates a nonviable pregnancy. Routine sonography primarily to assess the menstrual age should be performed in the second trimester, when added clinically relevant information may be obtained. Although it is possible to diagnose some anomalies in the first trimester, most remain second trimester sonographic diagnoses.
Congenital Abnormalities↗
Vitelline duct cyst or double yolk sac.
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Adult↗
In utero exposure to diagnostic ultrasound: a 6-year follow-up.
A 6-year follow-up study of height and weight was conducted between 1975 and 1983 in a total of 149 sibling pairs of the same sex, one of whom had been exposed to diagnostic ultrasound in utero. The data were analyzed for the entire sample group, as well as for subgroups defined by sex, gestational age at delivery, birth order, and gestational age at time of first exposure to ultrasound. No statistically significant differences of head circumference at birth or of height and weight between birth and 6 years of age were found between ultrasound-exposed and unexposed siblings. In our sample population, exposure of fetuses to ultrasound did not significantly affect growth in childhood up to 6 years of age.
Adolescent↗