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Biomedical subjects

G Bernaschek

Publications and source records attributed to G Bernaschek.

At least 109 records · Page 6Linked to original sources
PubMed1992

[The diagnostic value of rectal ultrasound in the assessment of parametrial infiltration of cervix cancer].

In addition to rectal palpation, rectosonography seems to be a promising method in pretherapeutic examination of the parametrium in patients with cervical carcinoma. To evaluate the usefulness of this examination we determined the sensitivity and specificity of rectal palpation performed by one examinator, rectal palpation performed by changing examiners, and rectal sonography. The results of the clinical examination of 128 parametria (64 women) were compared to histological findings following Wertheim-Meigs operation. Sensitivity and specificity were as follows one examiner 48% and 96%, changing examiners 44% and 94%, rectosonography 55% and 99%. In conclusion, we suggest that rectal sonography is a careful and moderate method that can be an important supplement to rectal palpation in pretherapeutic staging of cervical cancer.

Cervix Uteri↗
PubMed1992

Vaginosonographic velocimetry in uterine arteries before and after administration of beta-mimetics.

OBJECTIVE: To investigate the effect of surgical procedures at 15 weeks gestation (amniocentesis or cervical cerclage), with or without post-operative ritodrine prophylaxis, on uterine blood flow velocity waveforms and maternal heart rate. DESIGN: A quasi-randomized observational study. SETTING: University Department of Obstetrics and Gynaecology, Vienna. SUBJECTS: Sixty women having a genetic amniocentesis for advanced maternal age and 57 women having elective cervical cerclage for previous preterm labour or recurrent miscarriage. INTERVENTIONS: The women in each group were allocated either to receive prophylactic ritodrine postoperatively or to receive no ritodrine treatment. Allocation used the year of birth of the woman (odd years received ritodrine, even years received no treatment). All the women had vaginal ultrasound velocimetry studies in both mainstem uterine arteries through the parametrium before the surgical procedure and again after the procedure. The ritodrine-treated women in the cerclage group received intraveneous ritodrine hydrochloride (0.2 mg/min) and those in the amniocentesis group received 60 mg ritodrine/day orally. MAIN OUTCOME MEASURES: Uterine artery blood flow velocity waveform indices: A/B ratio and pulsatility index (PI) and maternal heart rate before and after the surgical procedure. RESULTS: The only statistically significant difference in haemodynamic values between those obtained before the procedure and those obtained after the procedure with or without prophylactic ritodrine was seen in the women who had cervical cerclage with postoperative intravenous ritodrine. The mean A/B ratio decreased from 2.69 (SD 1.17) to 2.11 (SD 0.44), and the mean PI from 1.62 (SD 0.47) to 1.21 (SD 0.3) and the mean maternal heart rate increased from 82.6 (SD 11.1) to 99.4 (SD 15.7). There were no other statistically significant differences between before and after haemodynamic values. CONCLUSIONS: There are no clinically relevant effects of amniocentesis and cervical cerclage on uterine blood flow velocity waveforms.

Adult↗
PubMed1991

Vaginosonographic Doppler velocimetry in both uterine arteries: elevated left-right differences and relationship to fetal haemodynamics and outcome.

Blood flow velocity was measured in both main stem uterine arteries by means of a transvaginally inserted Duplex scanner (240 degrees sector, pulsed Doppler) and visual vessel recognition to investigate normal and abnormal uterine perfusion. Its relationship to fetal circulation and fetal outcome was studied. Fetal vessels were investigated transabdominally. One hundred and seventy-six pregnancies with a high-risk for fetal malnutrition were examined between the 27th and the 40th week of gestation. In 113 (64%) patients we found normal uterine perfusion (A/B ratios in both uterine arteries less than 3, left-right difference less than 1) and in 63 (36%) cases the A/B ratios were outside our limits. A single abnormal A/B ratio in one of the uterine arteries or an abnormal left-right difference was classified as a mild form of abnormal uterine perfusion. Involvement of both uterine arteries was classified as a severe form. The severe form was associated with a higher frequency of pathological waveforms in fetal arteries and reduced fetal outcome. Clinically, velocimetry in both uterine arteries is of paramount importance when the degree of abnormal uterine perfusion is to be classified precisely.

Adult↗
PubMed1991

[Current status of vaginal ultrasound--a worldwide survey].

In the last five years, vaginosonography has become a routine procedure in Obstetrics and Gynaecology. Many obstetricians, gynaecologists, radiologists and ultrasonographers have recognized the advantages of this method. A number of manufacturers of ultrasound equipment offer several types of vaginal probes. Nevertheless, the rapid development of vaginosonography has led to some disadvantages concerning a standardised terminology and image display. In this study we collected data on the current standards of vaginosonography. To gain data on the current use of vaginosonography, we sent out questionnaires to the 1107 departments of Obstetrics/Gynaecology in the FIGO Registry of 1985. In an accompanying letter we asked the chairmen to pass on the questionnaire to the appropriate specialist. The questionnaire was designed to gather information about the personnel performing vaginosonography and such as technique, transducer frequency, position of the patient and image display used. We received 366 responses. Vaginosonographic investigations are performed in 84% of the Obstetrics/Gynaecological University Departments, of which 90% of vaginosonography was performed by an obstetrician or gynaecologist, 5% by a radiologist and 5% by a technician. Predominantly end firing scanners were preferred. The number of electronic and mechanical scanners were nearly identical (55% vs 45%). The preference for a scanner with a narrow (less than 120 degrees) or wide angle (greater than 120 degrees) was very similar (53% vs 47%). More than half of the replies indicated (54%) used a transducer frequency of 5 MHz, 46% preferred scanners with a frequency between 5.5 and 7.5 MHz. In 55%, the gynaecological examination table was considered superior to a flat table.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Cultural Comparison↗
PubMed1991

Prenatal diagnosis of a complex fetal cardiac malformation associated with asplenia.

A case of a complex fetal heart malformation with left isomerism, a "right sided" double outlet ventricle, and aortic isthmus stenosis combined with asplenia was diagnosed by ultrasonography at 26 weeks' gestation. The pregnancy was terminated at the request of the parents in the 27th week of gestation. Because the prognosis for a fetus with cardiosplenic syndromes depends mainly on the severity of the cardiac abnormality cases of visceral heterotaxy should be classified according to the predominant feature, the heart malformation.

Adult↗
PubMed1990

Assessment of female urinary incontinence by introital sonography.

By the use of a vaginal sector scanner, placed to the vaginal introitus (introital sonography), we studied the static and dynamic function of the urethrovesical region in patients with genuine stress incontinence and detrusor instability. Patients with genuine stress incontinence (n = 25) revealed either an increase of the retrovesical angle or the angle of inclination associated with a descent of the bladder neck during coughing. Opening of the bladder neck during cystometry, showing an increase of the detrusor pressure, was observed in patients with motor urge incontinence (n = 10). Application of the technique is recommended in patients with stress incontinence undergoing surgery for objective intraoperative assessment of successful reformation of the urethrovesical junction, irrespective of the surgical procedure. Compared with radiologic techniques, introital sonography has many advantages with no radiation exposure and with minimal inconvenience to the patient.

Female↗
PubMed1990

Vaginosonography and its diagnostic value in patients with postmenopausal bleeding.

Using a transvaginal 240 degrees "panorama" sector scanner (5.0 MHz) we performed a sonographic study in 106 women with postmenopausal bleeding before they had a diagnostic dilatation and curettage. Sonographic findings were classified as (1) normal thin endometrial echo, (2) pathologically thickened echo (i.e. more than 1/3 of the a.-p. diameter of the myometrial wall) and (3) spherical echoes representing myomas. We also looked carefully at the borders of the endometrium. 21 cases could not be included because of no histological specimen was available or because the vagina was too narrow for insertion of the probe. The histological and sonographic results were compared. Of 39 women with pathologically thickened endometrial echoes 12 had invasive carcinomas, 9 hyperplastic endometrium, 16 polyps and 2 had normal atrophic endometrium. In the 46 women with normal endometrial echoes 1 had a carcinoma (confined to the mucosa and obscured by a myoma), 1 had hyperplastic endometrium, 4 had small polyps (size below 5 mm) and 40 had normal atrophic endometrium.

Endometrium↗
PubMed1990

[Prenatal diagnosis of placental tumor using Doppler sonography].

Chorioangiomas are relatively frequent, benign and highly vasculated tumours of the placenta. In a few rare cases they show an excessive growth. Placental necrosis, preterm delivery and foetal asphyxia are well-known complications. Another severe complication is maternal thrombocytopenia, leading to serious thrombopathia. In cases with unfavourable examination conditions, it may be difficult to distinguish ultrasonographically between a chorioangioma and foetal elements. In our case, final diagnosis of a 10 by 9 cm chorioangioma became possible by the use of Doppler ultrasound. Arterial and venous signals were seen all over the tumour. During the following period of observation, the tumour did not grow and pregnancy was uneventful. Diagnosis of chorioangiomas should be made as early as possible to enable the obstetrician to adjust the management of pregnancy to complications that can be expected.

Adult↗
PubMed1989

Placental biopsy for rapid fetal karyotyping in the second and third trimesters of pregnancy.

Rapid chromosomal analysis in the 2nd and 3rd trimester of gestation is desirable in cases of suspected or proven fetal malformation. The presence of any chromosomal aberration of the fetus influences the further prenatal and perinatal management of the pregnancy. Placental biopsy and preparation of trophoblast tissue after short term culture offers the possibility of getting satisfactory results within 2 to 3 days of biopsy. Fifty-seven patients underwent placental biopsy between the 16th and 36th weeks of gestation because of sonographically suspected or proven fetal malformation. In 51 of 57 cases fetal karyotyping was successful and no severe complications after biopsy were seen. Eight pathologic karyotypes were found. In 3 cases the chromosomal analysis yielded unsatisfactory results because of the inadequate quality of metaphases. In another 3 cases not enough chorionic tissue was aspirated in 2 biopsy attempts. In all other cases normal fetal karyotypes were found. Sonographically guided placental biopsy represents a simple method for fetal karyotyping and is a useful tool for the management of pregnancies with suspected or proven fetal malformation in the 2nd and 3rd trimester.

Chorionic Villi Sampling↗
PubMed1989

Transvaginal pulsed Doppler velocimetry in fetal arteries.

Transabdominal pulsed Doppler velocimetry in fetal arteries might be difficult with extreme obesity, anhydramnios, cord presentation and an unfavourable position of the fetal head. A vaginal transducer gets closer to the presenting part of the fetus and therefore has advantages for Doppler velocimetry in fetal arteries.

Adult↗
PubMed1989

Transvaginal pulsed Doppler measurement of blood flow velocity in the ovarian arteries during cycle stimulation and after follicle puncture.

In experimental studies, an increase of the ovarian blood flow was found during cycle stimulation. In this study, the authors performed transvaginal pulsed Doppler measurements of the ovarian arteries in stimulated cycles before and after follicle puncture. Four days before follicle puncture, high flow velocities in systolis were found compared with diastolis. Toward the day of embryo transfer, a marked increase of the diastolic blood flow velocity was observed. In patients with high endocrine response, the pulsatility index (PI) was significantly lower compared with that of patients with low endocrine response. The technique of transvaginal pulsed Doppler measurements offers the possibility to study the alterations of the ovarian blood flow under physiologic and pathophysiologic conditions.

Adult↗
PubMed1989

[Comparison of transvaginal and transabdominal Doppler flow measurements in uterine vessels in the normal course of pregnancy].

Despite physiological and methodical drawbacks Doppler velocimetry in the arcuate arteries has become a standard for examination during pregnancy. Arcuate arteries are terminal branches of the uterine vaculature and supply only a circumscript area. Local vasoconstriction (due to contractions) and placental infarction may give erroneus results. Measurements in arcuate arteries at the site of placental insertion showed flow patterns different from those in the rest of the uterus. Since continuous wave Doppler systems were mostly applied, the received echoes could have originated from any part along the sound beam. Signals from arteries of the anterior abdominal wall may lead to "false pathological" waveforms. All these drawbacks have been overcome by Doppler velocimetry of the main stem uterine artery on its course through the parametrium by a transvaginal inserted probe that combines a 240 degrees "panorama" sector scanner with a pulsed Doppler system. Both main vessels supplying the uterus, i.e. left and right uterine artery, could be visually identified and pulsed Doppler velocimetry could be applied. This provided us with information about perfusion of the whole organ and showed us also the physiological range of left to right discrepancy in the flow patterns. In 63 pregnant women with a single foetus and an uneventful course of pregnancy we compared transabdominal measurements of the arcuate arteries with transvaginal measurements in both main uterine arteries. In 56 women we found pathological wave forms in the arcuate arteries (A/B ratio greater than 2) despite lack of clinical or transvaginal measured evidence of malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1989

[Transvaginal pulsed Doppler measurement of flow velocities in pelvic vessels following cycle stimulation].

The availability of pulsed Doppler probes has made it possible to sample signals at a chosen depth and thus to detect the flow in any selected deep vessel. Pulsed Doppler signal processing combined with real-time imaging, the so-called "duplex" method, is now also available for transvaginal transducers. The advantage of endosonographic ultrasound investigation is the possibility of using higher frequencies leading to a better resolution of anatomical structures of the small pelvis. Therefore this method allows the precise localisation of a deep vessel and the positioning of the Doppler sample volume within it. The transvaginal approach enables one to position the transducer close to the artery for better measurements. For our study we used a vaginal probe with 7.5 MHz with a pulsed Doppler equipment linked to a Combison 320 (Kretztechnik, Zipf, Austria). The integrated pulsed Doppler is not attached at a fixed angle but can be moved in the whole sector of 240 degrees. We investigated, if during follicle phase of the cycle changes of the pelvic blood flow velocity could be observed. 14 patients undergoing in vitro fertilization for sterility reasons participated in our study. We performed daily measurements of the blood-flow velocity of the ovarian artery and the internal iliac artery from cycle day 8 until the day of induction of ovulation. During cycle stimulation the observed decrease of the A/B ratio was dependent on cycle day and number of follicles. We found a decrease of the A/B ratio in the ovarian artery from 3.85 in cases with 2 follicles to 2.71 in cases with 5 follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1989

[Perineal sonographic procedures in gynecologic diagnosis of incontinence].

In this study, we compared perineal-sonographical findings with the results obtained by urethrocystography in 30 patients with genuine stress incontinence. The posterior urethrovesical angle and the angle of inclination were measured by both procedures. The radiological and sonographical findings correlated well. An increase of both angles during stress was found irrespective of the type of technique (p less than 0.001). Perineal scan is a simple and reliable non-invasive method, which also allows long-term dynamic echography with concomitant urodynamic investigations.

Adult↗
PubMed1989

[Color-coded Doppler sonography in pregnancy].

Recently the advantages of angiodynography have been reported for different purposes. The goal of this study was to find out the validity of colour flow mapping for obstetric patients. Additionally, we compared the obtained results with those obtained by conventional pulsed Doppler measurement. 30 women with an uneventful pregnancy were investigated. Angiodynography enabled us to depict a selected vessel quicker and to visualise the course of the investigated vessel. Furthermore, the new method of colour flow mapping and subsequent pulsed Doppler measurement results in visual vessel recognition of fetal and maternal vasculature and therefore subsequent Doppler measurement is also possible in small vessels. This method could be valuable for the diagnosis of high-risk pregnancies.

Adult↗
PubMed1989

A new method for sonographic urethrocystography and simultaneous pressure-flow measurements.

By the use of a vaginal scanner and simultaneous pressure-flow measurements, we developed a new method to study bladder and urethral function. During urodynamic pressure measurements, a vaginal scanner was positioned adjacent to the vulva just underneath the external urethral orifice to scan the bladder, the vesicourethral junction, and the urethra. This technique was termed "introital sonography." Twenty patients with the symptom of "loss of urine" and ten healthy volunteers without urinary symptoms were studied. Introital sonography displayed the bladder, the urethra, and the symphysis in all women. No incontinence was demonstrable in the healthy control group. Opening of the bladder neck was always visible during micturition, and a normal flow pattern could be observed in all healthy women. In five patients with detrusor instability, opening of the bladder neck was found during cystometry, displaying isolated detrusor contractions. Fifteen patients with genuine stress incontinence demonstrated marked descent of the vesicourethral junction under stressful situations. For the diagnosis of detrusor instability, sonographic visualization of bladder neck opening confirms the entity of isolated detrusor contractions during cystometry and thus helps to exclude tonometric artifacts. Introital sonography not only confirms the diagnosis of genuine stress incontinence by accurately demonstrating the abnormal vesicourethral anatomy, but also provides information that is essential for selecting the proper operative procedure. The lack of radiation exposure and contrast medium makes this inexpensive technique most useful for long-term video pressure-flow studies in patients with bladder dysfunction.

Female↗