Biomedical subjects

G Bernaschek

Publications and source records attributed to G Bernaschek.

At least 127 records · Page 7Linked to original sources

PubMed1989

Endosonography in obstetrics and gynecology: the importance of standardized image display.

The use of endosonographic methods (transvaginal sonography, transrectal sonography, cystosonography, hysterosonography) is increasing for diagnostic and therapeutic procedures in obstetrics and gynecology. Because different means of description lead to confusion, endosonography needs a defined method of orientation. The topography used for transabdominal sonography should also be employed for endosonography. When performing transabdominal sonography, the scanner surface is always projected to the top of the screen, regardless of whether the patient is investigated from a ventral or dorsal position. With endosonography, the contact surface of all linear arrays, curved arrays, and sector scanners should be projected to the bottom of the screen. Using a frontally radiating sector scanner or curved array for a sagittal section, the left side of the screen should correspond with dorsal and the right side with ventral; for all other sections, left and right must be defined. A standardized way of displaying images obtained by endosonography should project the scanner surface to the bottom of the image and can be used on all available technical equipment without major difficulty. The advantage of displaying endosonographic images in this standardized manner is the simple differentiation of pictures obtained by an endosonographic or transabdominal technique.

Female↗

PubMed1988

Cystosonography in the staging of gynecological malignancy.

Five patients with carcinoma of the cervix and one with carcinoma of the vagina were examined by both cystoscopy and endosonography. Both techniques revealed malignant infiltration of the bladder in 4 patients. In the other 2 cystoscopy showed an intact bladder mucosa despite cystosonographic evidence of invasion of the bladder wall by tumor.

Aged↗

PubMed1988

A comparative study of perineal ultrasound scanning and urethrocystography in patients with genuine stress incontinence.

Perineal scanning using linear array ultrasound was used as an alternative to radiologic urethrocystography in the investigation of female urinary incontinence. The posterior urethro-vesical angle (beta) and the angle of inclination (alpha) of 30 patients (age: 48 +/- 10.2 years) with genuine stress incontinence were measured by both procedures. In all cases the radiologic and ultrasound findings correlated well. Perineal scan provides similar information to that obtained by the radiographic procedure without exposure to X-rays. In contrast to urethrocystography perineal scan is fast, inexpensive, readily accessible and more acceptable to the patient.

Adult↗

PubMed1988

Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy.

We first performed a vaginosonic scan and then determined the serum human chorionic gonadotropin (beta-hCG) concentration (Second International Standard) in 52 women at an early gestational age to establish criteria for the earliest possible identification of an intrauterine pregnancy by this new ultrasound technique. The smallest diameter of a gestational sac detected was 2 mm, and the lowest beta-hCG concentration was 141 mIU/ml when an intrauterine pregnancy was correctly diagnosed. Between 50 and 280 mIU/ml, six out of eight pregnancies in this range were not seen. However, all pregnancies associated with beta-hCG concentrations greater than 300 mIU/ml were correctly identified. Taking into account the rapid growth of the conceptus and the exponential increase of serum beta-hCG by a factor of 1.7 per day at this early gestational age, we presume that a gestational sac at beta-hCG concentrations of 750 mIU/ml should not be missed by vaginosonography (safety margin of the discriminatory zone), even in instances of a retroverted uterus. No false-positive vaginosonographic findings were observed in this study. A vaginosonographic examination is a short and well-tolerated procedure that can be performed in a physician's office. The use of a 5 MHz transducer placed in the vagina provides better resolution and image quality. This overcomes imperfect anatomy and other physical factors that interfere with good imaging. The vaginosonographic examination provides information on the anatomic location of the gestational sac, with the highest reliability and accuracy around the time a woman misses her menstrual period. It can be very useful in the differential diagnosis of an ectopic pregnancy.

Chorionic Gonadotropin↗

PubMed1988

Vaginosonographic velocimetry of both main uterine arteries by visual vessel recognition and pulsed Doppler method during pregnancy.

In 88 pregnant women (7 to 40 weeks' gestation) we performed Doppler velocimetric studies of the uterine artery on its course through the parametrium by means of the newly developed, frontally radiating duplex sector scanner. This device enabled us to visually recognize the vessel and apply the more refined pulsed wave system. In 71 of 88 women, we were able to obtain measurements from both uterine arteries. We found significant differences in the maximum systolic to minimum diastolic frequency shift (A/B ratio) up to 4 between the right and left vessels in the first and second trimester. In the third trimester, the differences almost disappeared (mean +/- SD A/B ratio difference 0.4 +/- 0.3) in these uncomplicated pregnancies. We also report our mean values (first, second, and third trimesters) of the A/B ratio and the pulsatility index as an average from the right and left side measurements. Both values declined during the course of pregnancy (A/B ratio, 5.5, 2.9, and 2.1; pulsatility index, 2.5, 1.7, and 1.3). We conclude that, with some experience, this scanner has the advantage of visually recognizing the vessel under study and allows measurements in both main uterine arteries. The average of the right and left measurements provides a better summary of uterine perfusion. Due to the significant right/left difference in the A/B ratio, unilateral measurements of the uterine artery may give erroneous results during the first and second trimesters. Theoretically, the pulsed system provides a "cleaner" signal, but the values are comparable to those of devices that apply a continuous wave system.

Arteries↗

PubMed1988

[Pulsed Doppler flow measurements using a vaginal ultrasound probe--integration into fetomaternal hemodynamics].

A recently developed "Panorama" sector scanner emitting in frontal direction (KretzTechnik, Zipf, Austria), combined with pulsed Doppler signal processing, makes it possible to visualize the main branch of the uterine artery already during its passage through the parametrium, and to adjust the Doppler beam under visual control. This makes it possible for the first time to receive flow signals that are free from superimpositions and are reliable, from both vessels supplying the pregnant uterus. It was the aim of our study to describe the haemodynamic changes at the uterine arteries in the course of pregnancy and to collect first experiences on the blood flow of the entire uterus. 42 women with an uneventful course of pregnancy were examined between the 8th and the 40th week of pregnancy. Angle-independent parameters such as the A/B ratio and pulsatility index dropped significantly during the course of pregnancy. The A/B ratio dropped from 5.4 during the first trimenon to 2.2 during the third trimenon, and the pulsatility from 2.6 to 1.3. This new method makes it possible to receive at more reliable and in respect of the total blood flow of the uterus more representative values for insertion into the second part of the haemodynamic equation for the pregnant uterus.

Arteries↗

PubMed1988

[Comparison of Doppler flow measurements of the arcuate artery and uterine artery in fetal growth retardation].

Transabdominal Doppler velocimetry in the arcuate arteries has been the widest used technique for the assessment of uterine perfusion despite theoretical and physiological drawbacks. The size of arcuate arteries is beyond the resolution of modern scanners. They represent terminal branches of the uterine vasculature and do not provide information regarding total uterine blood supply. Transvaginal Doppler velocimetry of the main uterine arteries on its course through the parametrium by means of a newly developed frontally radiating 240-degree "panorama" sector scanner promised a solution. The aim of the study was to compare the A/B ratios in both arteries (i.e. arcuate vs. main uterine) in pregnancies with a growth retarded fetus below the 10th percentile, as defined by ultrasound biometry. We wondered firstly which vessel better demonstrates velocity waveforms leading to growth retarded newborns defined by a birth weight beyond the 10th percentile (Hohenauer) and secondly, how frequently pathological A/B ratios in the uterine vessels are associated with pathological A/B ratios in the umbilical arteries. In 25 growth retarded fetuses (ultrasound biometry), we found more often pathological waveforms in the arcuate arteries (n = 20) than in the main uterine arteries (n = 18). Pathological waveforms in all three vessels (arcuate, main uterine, umbilical) were found in 12, in the arcuate and umbilical vessels in 13, and in the main uterine and in umbilical artery in 17 cases. Six fetuses were within the normal weight range at delivery indicating normal fetal growth. Pathological A/B ratios in the main uterine artery were more often associated with a growth retarded newborn.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Cystosonography: a diagnostic adjunct for the staging of advanced gynecologic malignancies.

Thirty-five patients with advanced gynecologic malignancies (cervical cancer, N = 26; endometrial cancer, N = 5; ovarian cancer, N = 2; vaginal cancer, N = 2) underwent cystoscopy and subsequent cystosonography. The mean age was 61.6 years (range 33-78). The bladder wall was found intact in three patients regardless of the diagnostic procedure. A mere displacement of the bladder wall was observed in four cases using cystoscopy. In all of these women, tumor invasion was ascertained by cystosonography alone. Edema of the bladder mucosa was found in 14 women by cystoscopy and in six women by cystosonography. Endosonography detected tumor invasion of the external layers of the bladder in eight of 14 women. In six of 14 patients, edema was caused by bladder displacement without neoplastic infiltration. Tumor invasion of the bladder was ascertained in six women by cystoscopy and intravesical sonography. Both cystoscopy and intravesical sonography demonstrated neoplastic infiltration and edema of the bladder mucosa in eight patients. Compared with cystoscopy, cystosonographic demonstration of the perivesical region provided better evaluation of the extent of bladder invasion. Cystosonography is a diagnostic adjunct to mere cystoscopy for patients with gynecologic malignancies. This modality is an excellent diagnostic tool, especially if cystoscopy reveals pathologic findings such as edema and displacement or invasion of the bladder wall.

Adult↗

PubMed1987

[Comparison of vaginosonographic, transabdominal sonographic and laparoscopic follicle puncture for the retrieval of oocytes within the scope of an in vitro fertilization program].

For follicular aspiration and oocyte retrieval for in-vitro-fertilization (IVF) laparoscopy, laparotomy and different ultrasound guided methods like transvesical and transvaginal puncture can be used. Sonographically guided follicular aspiration has become more important because this procedure is less invasive. In this study we compared the results of 28 laparoscopical, 35 transabdominal and 21 transvaginal follicle puncture after successful cycle stimulation. Performing transvaginal puncture 4.7, using laparoscopy 3.4 and performing transvesical puncture 2.0 oocytes per attempt were retrieved. The advantages of transvaginal follicle aspiration were a shorter operation time, a superficial anesthesia and compared to laparoscopy a less invasive and simple technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Female↗

PubMed1987

Comparison of the results of vaginal and abdominal follicle scans.

The hormonal profile and sonographical assessing of the number and size of the follicles are important in hyperstimulated cycles. Follicular imaging obtained by abdominal scanning may be distorted by echoes from the intestine or by unfavourable location of the ovaries and patients must have a full bladder. We compared the number and size of the follicles at abdominal sonography with the results obtained by vaginal sonography in 37 patients. Vaginal sonography showed more follicles than abdominal sonography because of improved imaging of small follicles on early days of cycle. This might help one to tailor the hyperstimulation to an individual's endocrine response.

Adult↗

PubMed1987

Vaginosonographical determination of the true conjugate and the transverse diameter of the pelvic inlet.

In suspected cases of cephalopelvic disproportion pelvic measurement and the estimation of the fetal weight can be essential for the management of labor. We measured the true conjugata and the widest transverse diameter of the pelvic inlet with a new vaginal scanner. The biparietal diameter (BPD) was measured with a real-time sector scanner. The results of vaginosonographical measurement were compared and showed good correlation with both conventional radiological measurement and measurements obtained by a compound scanner. Vaginosonographical measurement which causes no pain, is quick and also allows measurement of the transverse diameter of the pelvis, might become a routine method in all suspected cases of cephalopelvic disproportion.

Birth Weight↗

PubMed1987

Follicular aspiration for in vitro fertilization: sonographically guided transvaginal versus laparoscopic approach.

Laparoscopy is the most commonly used procedure for oocyte retrieval in an in-vitro fertilization (IVF) program. In this study we compared the results of 21 laparoscopic and 21 sonographically guided transvaginal oocyte retrievals using a vaginal probe. Laparoscopically 3.7 and transvaginally 4.8 oocytes per patient were recovered. Overall 6 pregnancies were achieved, giving a pregnancy rate of 14.1% per patient. Vaginal follicular aspiration resulted in a higher oocyte recovery rate. The advantages of the method were a shorter operation time, a superficial anesthesia and, compared to laparoscopy, a less invasive and simpler technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Adult↗

PubMed1987

[Endosonographic diagnosis in uterine tumors].

Endosonography offers two major advantages in the pretherapeutic examinations of a histologically verified carcinoma of the uterus. Endosonography allows (1) an overview of the size and location of the tumour and (2) an evaluation of the spreading and/or involvement of adjacent organs. Both add up to a more objective staging of the tumour and, therefore, may cause a more effective therapeutic approach. Especially in cases with endometrial carcinoma the uterine walls can be visualized either by the well-tolerated method of vaginosonography or by hysterosonography which can be performed only in general anaesthesia. Applying either endosonographical method, the infiltration depth of the myometrium and/or involvement of the cervix can be determined, which seems to be very valuable, particularly when differentiating between stages I and II. Rectosonography, with its transversal scanning probes, offers the advantage of demonstrating the infiltration of a cervical tumour into the parametrium. Here again, the benefit is seen in a more objective evaluation of tumour size and extension. However, tumour growth into the urinary bladder is best shown by cystosongraphy. With this method one cannot only have a view of the epithelium (as in cystoscopy) but one is also able to evaluate the underlying layers of the bladder wall. This seems to be an advantage in findings of a bullous oedema. Once again, rectosonography is advantageous in enhancing the diagnosis of recurrences of malignant tumours in the pelvic region. Like a prolongation of the palpating finger rectosonography is able to depict less echogenic areas located high up on the pelvic wall as local recurrences or tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervix Uteri↗

PubMed1987

[Advantages of endosonographic diagnosis in gynecology and obstetrics].

By echographic standards, the first applications of endosonography in gynecology and obstetrics are already in the distant past. However, only the continued development of ultrasonographic scanners and the improved imaging of endosonographic findings resulting from this have made it possible to establish that, with many indications, endosonography is superior to abdominal sonographic diagnosis. Vaginosonography in particular offers much additional information in examination of the true pelvis, especially in patients with extensive adhesions following surgery or radiation therapy, or with inflammations and endometrioses. As a result of the higher resolution, made possible by the use of higher frequencies for examination, there are also advantages in early detection of pregnancy, in assessment of cervix insufficiency, placenta previa, and especially for measurement of the pelvis. Vaginosonography has also enhanced diagnosis in folliculometry, demonstration of the endometrium, and echographically aimed punctures in the true pelvis. However, it also offers an important advantage for the gynecologist, in that he can use it immediately after palpation to clarify any uncertainties (the patient need not have a full bladder). The principal applications of hysterosonography, rectosonography, and cystosonography are in the staging of corpus and cervix carcinomas and in detecting recurrences.

Female↗

PubMed1987

[Computer-assisted documentation and recording of findings of obstetrical ultrasound findings].

Since 1976 on our department obstetrical reports are generated and stored by computer. This kind of documentation has been also introduced for obstetrical ultrasound investigations. One year ago the part of our database for storing and recording the results of obstetrical ultrasound examinations was changed according to new purposes. This system was designed to support diagnosis of pathological findings and to arrange the results more clearly. Immediately after the investigation the results are entered in a terminal (3278 IBM). Our database is a CICS (Customer Information Computer System) application of the WAMIS (Wiener Allgemeines Medizinisches Informationssystem) from the IMC (Institut für Medizinische Computerdokumentation). The results of the investigation are printed after storage in the data base. The screen and the obtained print-out are divided into several sections according to medical purposes. Since the results of fetal measurement are displayed graphically, fetal growth and the change of normal or abnormal findings can be judged immediately. The new layout of the hardcopy of the results of our ultrasound investigations improves diagnosis of pathological findings. Each examinator is forced to visualize fetal organs, signs of fetal vitality and to perform standardized measurement. Therefore, the possibility to find pathological alteration is improved especially if the investigator is less experienced.

Computers↗

PubMed1987

Fetal kidney volume and urine production in cases of fetal growth retardation.

The amount of amniotic fluid has a close correlation to the function of the fetal renal system. In many cases of fetal growth retardation oligohydramnios is obvious. The aim of this study is the investigation of the hourly fetal urine production rate (HFUPR) and the growth of fetal kidneys during pregnancy in cases of fetal growth retardation and to evaluate the renal participation in the origin of oligohydramnios in cases of growth retardation. In 52 healthy pregnancies and 27 cases with known fetal growth retardation, the volume of the fetal kidneys was measured sonographically and the hourly rate of fetal urine production was determined. Two third of the patients with fetal growth retardation had obvious oligohydramnios. In cases of fetal growth retardation the volume of the fetal kidneys was significantly smaller when compared to the control group, and the volume of fetal urine production was significantly lower. The reduced perfusion of the fetal kidneys in those cases with fetal growth retardation may be the reason for the reduction of the HFUPR. Due to the fact that HFUPR is a dynamical parameter and in close relationship to the perfusion of the fetal kidneys, the identification and measurement of this parameter may help to detect subacute and imminent fetal distress in cases of sonographically proven fetal growth retardation.

Adult↗

PubMed1986

[Normal sizes of internal genitals in girls before and after the menarche].

Knowledge of the average size of the organs of the true pelvis is a prerequisite for the diagnosis and treatment of suspected disorders of the uterus and ovaries in children and adolescents. 76 girls in the premenarche (age = 1 to 14 years) and 31 girls in the postmenarche (age = 13 to 18 years) underwent ultrasound investigation of the inner genitals. Firstly, measurements of the uterus were taken in three dimensions. The volumes of the ovaries were calculated from 3-dimensional measurements of ovarian size. The results of measurements and calculations were used to establish median values and 10th and 90th percentile. Our results show nearly linear growth of the uterus and the ovaries between the 2nd and the 14th year of age. After the menarche accelerated growth of the organs of the true pelvis was detectable in all dimensions.

Adolescent↗

PubMed1986

Endosonographic staging of carcinoma of the uterine cervix.

The advantages of a new endosonic technique for staging carcinoma of the cervix are demonstrated. Using this method virtually all palpable findings can be objectified, and in most cases, assessing the size of the tumor inside the cervix seems to allow further differentiation in stage Ib. By imaging the parametrium, rectal sonography provides an important diagnostic aid for making the differentiation between stages Ib, IIb and IIIb. For assessment of the extent of vaginal infiltration, rectal ultrasound diagnosis and in particular vaginosonography can be used. Rectal and especially transurethral sonography are useful for detecting an infiltration of the bladder wall and for further evaluation of cystoscopically visible vesiculated oedema.

Female↗