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Biomedical subjects

M C Frates

Publications and source records attributed to M C Frates.

31 records · Page 2Linked to original sources
PubMed1994

Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program.

This is a report of three cervical pregnancies, one of which was a heterotopic twin cervical pregnancy that occurred in combination with a single intrauterine pregnancy. Transvaginal ultrasound examination was sufficient to establish the diagnosis in two of three patients, and MRI scanning was conclusive in the third. Early diagnosis lead to intervention before 7 weeks gestation in all cases with no complications. The incidence of cervical pregnancy may be higher in IVF-ET than recognized previously.

Adult↗
PubMed1994

Ovarian masses: can benign and malignant lesions be differentiated with color and pulsed Doppler US?

PURPOSE: To determine whether color and pulsed Doppler ultrasound (US) can be used to differentiate benign from malignant ovarian masses. MATERIALS AND METHODS: Forty-four ovarian masses identified with sonography in 40 patients were confirmed at surgery (n = 35) or followed up to resolution with US (n = 9). Color and pulsed Doppler US were used to calculate the lowest pulsatility index (PI) and resistance index (RI) for each mass. RESULTS: Color Doppler US enabled detection of arterial flow in 24 of 36 benign masses and six of eight malignant masses. PI was lower in malignant masses than in benign masses (P = .002), as was RI (P = .001). Both indexes demonstrated overlap between benign and malignant masses; therefore, no cutoff value for either index had both high sensitivity and high specificity for malignancy: For PI cutoff of 1.0, sensitivity and specificity were 100% and 46%, respectively; for RI cutoff of 0.4, 50% and 96%. CONCLUSIONS: While PI and RI tend to be lower in malignant ovarian masses, neither index can be used reliably to differentiate benign from malignant lesions. In addition, lack of detectable flow by means of color Doppler US does not exclude ovarian malignancy.

Adult↗
PubMed1994

Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US.

PURPOSE: To determine whether sonography can help diagnose tubal rupture in patients with ectopic pregnancy. MATERIALS AND METHODS: The authors reviewed the transvaginal ultrasound (US) scans and medical records of 132 consecutive patients with tubal pregnancy confirmed at surgery performed within 24 hours of undergoing US. RESULTS: Adnexal masses were seen in 93 patients at US. Thirty-four patients had a tubal ring, and 59 had a complex mass. The frequency of tubal rupture was similar for both groups. The adnexal mass was significantly smaller in patients without a ruptured tube, but there was considerable overlap. Rupture was present in 21% of patients with no sign of or a trace of intraperitoneal fluid, increasing steadily to 63% in patients with a large amount of free fluid. Even though the amount of fluid was the best predictor of rupture, it was not completely reliable, as 37% of patients in whom a large amount of fluid was found had intact tubes. CONCLUSION: No finding at transvaginal US is a reliable indicator of rupture. Contrary to findings from previous studies, the appearance of the adnexal mass, if present, is not related to tubal rupture.

Fallopian Tube Diseases↗
PubMed1994

Cervical ectopic pregnancy: results of conservative treatment.

PURPOSE: To review experience with early sonographic diagnosis and fertility-preserving treatment of cervical ectopic pregnancy. MATERIALS AND METHODS: The authors evaluated 12 consecutive cases of cervical ectopic pregnancy diagnosed with ultrasound (US) and treated with methods that successfully preserved the uterus. Gestational age, sonographic findings, means of conception, and method of treatment were recorded. RESULTS: Gestational age at diagnosis ranged from 5.0 to 7.9 weeks. Cardiac activity was documented in nine cases. Patients were treated as follows: transvaginal US-guided injection of potassium chloride into the embryo or gestational sac (n = 6), uterine artery embolization followed by dilation and evacuation (n = 4), dilation and evacuation after ligation of uterine artery branches (n = 1), and uterine artery embolization followed by administration of systemic methotrexate (n = 1). The cervical pregnancy was successfully ablated with one treatment in all cases. No patient required hysterectomy, and only one patient required transfusion. Two patients subsequently delivered healthy babies; three other patients have been able to conceive successfully. CONCLUSION: When cervical ectopic pregnancy is diagnosed early, US-guided termination or other conservative procedures allow preservation of the uterus, thus maintaining potential fertility.

Cervix Uteri↗
PubMed1994

Sonography of the fetal posterior fossa: false appearance of mega-cisterna magna and Dandy-Walker variant.

PURPOSE: To establish that incorrect scanning of the fetal posterior fossa may falsely create the appearance of a mega-cisterna magna (MCM) or Dandy-Walker variant (DWV). MATERIALS AND METHODS: After routine sonography, 100 consecutive fetuses (gestational age range, 25-40 weeks) without abnormality underwent additional posterior fossa scanning in an attempt to create the appearance of an MCM (anteroposterior diameter larger than 10 mm) or DWV. Sonograms were obtained in a plane inferior to or angled more coronally than the routine axial plane. RESULTS: The posterior fossa was depicted in 93 fetuses. Pseudo-MCM occurred in 35 (38%) of 93 fetuses: 12 (30%) of 40 fetuses aged 25.0-29.9 weeks, 11 (50%) of 22 fetuses aged 30.0-34.9 weeks, and 12 (39%) of 31 fetuses aged 35.0-40.0 weeks. Pseudo-DWV occurred in 40 (43%) of 93 fetuses: 20 (50%) of 40 fetuses aged 25.0-29.9 weeks, 12 (55%) of 22 fetuses aged 30.0-34.9 weeks, and eight (26%) of 31 fetuses aged 35.0-40.0 weeks. CONCLUSION: Sonography of the posterior fossa in an angled semi-coronal plane should be avoided because it may create an appearance that mimics an abnormality.

Artifacts↗
PubMed1994

Distal ureteral calculi: detection with vaginal US.

PURPOSE: To describe the use of vaginal ultrasonography to identify distal ureteral calculi and hydroureter. MATERIALS AND METHODS: Abdominal and vaginal sonography were performed in 13 women with distal ureteral calculi. Indications for sonography included flank pain, hematuria, and suspected appendicitis. Six patients were pregnant. RESULTS: In each patient, vaginal sonograms demonstrated a distal ureteral calculus; in only two cases was the calculus detected with transabdominal sonography. Distal hydroureter was identified with vaginal scanning in each patient but with abdominal scanning in only two. Hydronephrosis was absent in three patients, mild in six, and moderate in four. Symmetric ureteral jets were noted at transabdominal sonography in two of nine patients. Follow-up transvaginal scans obtained shortly after passage of stones in two patients revealed swelling of the trigone but normal ureteral jets. CONCLUSION: In symptomatic female patients, use of vaginal sonography should be considered to evaluate the distal ureter for calculi, particularly if the results of transabdominal examination are normal or inconclusive.

Adult↗
PubMed1994

Clinical significance of isolated fetal pericardial effusion.

Prenatal sonographic identification of a small rim of pericardial fluid, measuring less than 2 mm in thickness, is a normal finding. Pericardial fluid 2 mm or greater in thickness may be associated with structural anomalies or hydrops, but its clinical significance in the absence of these associated findings has not been evaluated. We assessed the outcome in fetuses with isolated pericardial effusions of at least 2 mm thick. Our study population included 52 fetuses with effusions ranging from 2 to 7 mm in thickness. We compared rates of preterm delivery, cesarean section, intrauterine growth retardation, perinatal complications, Apgar scores, and length of neonatal hospital stay in these 52 cases to the overall hospital rates and found no statistically significant difference. We conclude that in the absence of other sonographic abnormalities, the finding of a fetal pericardial fluid collection 2 to 7 mm in thickness is not associated with adverse outcome.

Female↗
PubMed1993

Sonography of the fetal heart: normal variants and pitfalls.

Sonographic evaluation of the fetal heart is an important part of obstetric sonography. The sonographer and sonologist should be familiar with the sonographic appearance of the normal fetal heart and with common structural abnormalities. Occasionally, normal structures in or adjacent to the fetal heart may simulate an abnormality. Although one should seek consultative sonography in instances of uncertain or questionable findings, unnecessary referral and concern may be avoided in some cases if the sonologist is familiar with normal variants and pitfalls. In this pictorial essay, we present several such pitfalls that we and others have observed in the four-chamber view (Fig. 1) and in views of the ventricular outflow tracts (Figs. 2 and 3).

Female↗
PubMed1993

Pregnancy outcome after a first trimester sonogram demonstrating fetal cardiac activity.

We conducted a prospective study to assess pregnancy outcome after a first trimester sonogram demonstrating a singleton intrauterine gestation with fetal cardiac activity. In each of the 556 cases, data recorded included indication for the sonogram, results of the sonogram, and pregnancy outcome. Sonographic abnormalities were found more frequently in patients scanned because of symptoms (14.0%) than among patients scanned for routine indications (6.0%) (P < 0.05, chi-squared). Among 556 patients with known outcomes, the overall loss rate was 9.4%. A trend was seen toward a higher loss rate in patients with abnormal than normal sonograms (15.2% versus 8.8%). The loss rate after a normal scan was similar in symptomatic (10.6%) and asymptomatic patients (9.1%) and declined progressively with gestational age from 17.0% at 6 to 7.9 weeks to 4.3% at 12 to 13 weeks (P < 0.01, chi-squared). These results can be used to convey prognostic information to patients after a normal first trimester sonogram demonstrating fetal cardiac activity. The likelihood of a good pregnancy outcome can be stated as a function of gestational age, and a symptomatic patient can be reassured after a normal scan that her prognosis is similar to that of an asymptomatic patient with a normal sonogram.

Abortion, Spontaneous↗
PubMed1990

Congenital tracheoesophageal fistula (H-type) in a six-year-old.

The case of a six-year-old boy with newly diagnosed tracheoesophageal fistula of the H-type is presented. This diagnosis is usually made in the neonatal period, but since the symptoms may mimic other respiratory illnesses and radiologic diagnosis may be difficult, the condition may go undiagnosed for years. Since correction of a tracheoesophageal fistula is curative, the diagnosis should be entertained in any child with recurrent respiratory symptoms, especially when associated with meals. A brief discussion emphasizes the importance of good communication between the clinician and radiologist and of careful radiologic evaluation.

Child↗