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Biomedical subjects

S Kupesic

Publications and source records attributed to S Kupesic.

At least 37 records · Page 2Linked to original sources
PubMed1998

Preoperative diagnosis of primary fallopian tube carcinoma.

INTRODUCTION: Transvaginal color and pulsed Doppler can detect areas of neovascularization within the tubal carcinoma and can distinguish it from other benign adnexal pathology. SUBJECTS AND METHODS. During a 7-year period eight cases of Fallopian tube carcinoma were detected using transvaginal color and pulsed Doppler. RESULTS: Transvaginal sonography revealed complex, sausage-shaped, and/or cystic structures in the adnexal region. Additional color Doppler examination depicted low vascular impedance (RI ranged from 0.29 to 0.40). Histopathology reported different types of Fallopian tube carcinoma. CONCLUSION: Transvaginal color Doppler may aid in diagnosis of Fallopian tube malignancy more reliably than using other costly diagnostic procedures.

Adenocarcinoma↗
PubMed1998

Parallel Doppler assessment of yolk sac and intervillous circulation in normal pregnancy and missed abortion.

This study assessed yolk sac morphology and vascularity and intervillous blood flow in normal early pregnancy and missed abortion. Transvaginal colour and pulsed Doppler were used in a prospective analysis of 87 normal pregnancies and 48 missed abortions between 6 and 12 weeks gestation. The Kruskal-Wallis rank test was used to calculate the difference in yolk sac diameter and vascularity visualization rate between gestational weeks. Repeated measures analysis of variance was used for comparison of the intervillous circulation between groups. The growth of the yolk sac was considered statistically significant between gestational weeks 6 and 9, being most prominent between 9 and 10 weeks of gestation. Vascularity of the yolk sac, characterized by low velocity and absence of diastolic flow, was demonstrated in 67 per cent of normal pregnancies. Yolk sac blood flow was detected in 19 per cent of the patients with missed abortion. Doppler analysis of the intervillous circulation demonstrated decreased peak velocity of the continuous flow in patients with missed abortion for gestational weeks 11 and 12. It is concluded that progressive decrease of yolk sac vascularity coincides with visualization of more prominent colour-coded areas within the intervillous space. In patients with missed abortion, such changes do not occur.

Abortion, Missed↗
PubMed1998

Septate uterus: detection and prediction of obstetrical complications by different forms of ultrasonography.

The aims of the study were to compare the accuracy of transvaginal ultrasonography, transvaginal color Doppler sonography, hysterosonography, and three-dimensional ultrasonography in detection of septate uterus and to evaluate the occurrence of obstetrical complications in relation to septal dimension and vascularity. Each patient underwent transvaginal ultrasonography and color Doppler examination, whereas hysterosonography and three-dimensional ultrasonography were carried out in 76 and 86 patients, respectively. The sensitivity of different sonographic imaging modalities ranges between 95.21% and 99.29%. Color and pulsed Doppler sonographic studies of the septal area revealed vascularity in 71.22%. Patients with vascularized septa had a higher prevalence of obstetrical complications than those with avascularized septa (P < 0.05). Three-dimensional ultrasonography and hysterosonography are highly accurate diagnostic tools for detection of uterine septa. We found no correlation between septal dimension and rate of obstetrical complications, although pregnancy loss was most likely to occur in patients with vascularized septa.

Female↗
PubMed1998

Diagnosis and treatment outcome of the septate uterus.

AIM: To compare the accuracy of transvaginal ultrasound, transvaginal color Doppler, hysterosonography, and three-dimensional ultrasound in the detection of septate uteri. To evaluate obstetrical prognosis of the septate uterus and to assess the reproductive outcome following operative hysteroscopy. PATIENTS AND METHODS: Four hundred and twenty infertile patients undergoing hysteroscopy were evaluated prospectively during a 4 year period. Transvaginal ultrasound and color Doppler were performed in all patients, whereas hysterosonography and three-dimensional ultrasound were used in 76 and 86 patients, respectively. RESULTS: The sensitivity of transvaginal ultrasound and transvaginal color Doppler in the identification of the septate uterus was 95.0% and 99.3%, respectively. Color and pulsed Doppler studies of the septal area revealed vascularity in 71.2%. The sensitivity of hysterosonography and three-dimensional ultrasound in the detection of the septate uterus were 100% and 93.6%, respectively. However, the latter method predicted the existence of a congenital uterine defect in all the patients with septate uterus, but was inaccurate in differentiating it from other fusion anomalies. The pregnancy rate in 116 patients following the operative hysteroscopy for an intrauterine septum in a prospective follow-up period of 24 months was 50.9%: 44 patients (74.6%) had term deliveries, 11 (18.6%) had first trimester abortion, and 4 (6.8%) had preterm delivery. CONCLUSIONS: Transvaginal color Doppler and hysterosonography are highly accurate diagnostic tools for preoperative evaluation of the uterine cavitary defects. Three-dimensional ultrasound increases the accuracy of conventional two-dimensional transvaginal scan, allowing precise reconstruction of the uterine cavity. Removing the intrauterine septum in patients suffering from infertility and recurrent pregnancy wastage is beneficial.

Adult↗
PubMed1997

Doppler assessment of the intervillous blood flow in normal and abnormal early pregnancy.

OBJECTIVE: To compare resistance index (RI) and pulsatility index (PI) in the spiral and intervillous arteries, and peak systolic velocity of the continuous intervillous flow in normal and abnormal first-trimester pregnancy. METHODS: Transvaginal color and pulsed Doppler were used in a prospective analysis of 60 normal (controls) and 54 abnormal (30 missed abortions and 24 anembryonic) pregnancies (6-12 weeks' gestation). Repeated-measures analysis of variance was used for comparison between groups. RESULTS: A gradual decrease in spiral artery RI and PI was found in women with anembryonic pregnancies. No difference in spiral artery impedance was noted in women with normal pregnancies, but there was a progressive increase in spiral artery RI and PI in women with missed abortion. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward in the normal pregnancy group (8.0 +/- 0.9 versus 12.2 +/- 1.4 cm/second). Intervillous arterial blood flow signals did not demonstrate any difference in RI and PI with advancing gestational duration. Significantly lower PI values were obtained from the intervillous arteries in women with anembryonic pregnancy (PI 0.54 +/- 0.04) than in controls (PI 0.80 +/- 0.04) and those with missed abortions (PI 0.75 +/- 0.04). However, there was no statistically significant difference in the intervillous RI between subgroups. CONCLUSION: The new generation of sensitive Doppler units can detect intervillous flow as a continuous progressive process during the first trimester of normal and abnormal pregnancy. There is a significant difference in intervillous artery vascular impedance between normal and anembryonic pregnancies.

Adult↗
PubMed1997

A combined Doppler and morphopathological study of ovarian tumors.

OBJECTIVE: To evaluate intratumoral blood flow in 46 patients with ovarian masses. METHODS: Transvaginal color Doppler was carried out in each patient prior to the laparoscopy or laparotomy. Tumors were analyzed according to the size, morphology, presence of the neovascularization, configuration and distribution of the tumoral blood vessels and pattern of the intratumoral blood flow. Vascular patterns of surgically removed tumors were studied microscopically. Three types of vasculature were analyzed: neovascular capillaries without media, sinusoidal thin walled spaces and normal vessels' morphology. The RI (resistance index) values were analyzed in relation to gross appearance, histological type of the tumor, existence of inflammation/necrosis area and vascularization pattern of the tumor. RESULTS: Neovascularization was found in all the malignant tumors with low RI (less than 0.42) and solid or solid cystic gross morphology. Neovascular signals were obtained in only one patient with ovarian endometrioma. Sinusoidal spaces were identified in all the malignant ovarian tumors, but also in most of the benign lesions. Normal vessel morphology was identified in 60% of malignant ovarian tumors and in all the patients with benign ovarian lesions. CONCLUSION: There is a significant correlation between Doppler and histopathological studies in terms of vascularization pattern analysis (detection of neovascular capillaries, sinusoidal spaces and normal vessels morphology). In most of the malignant ovarian tumors there were few areas of vascularization which can be analyzed non-invasively by transvaginal color and pulsed Doppler ultrasound.

Adult↗
PubMed1997

The assessment of uterine and ovarian perfusion in infertile patients.

OBJECTIVE: To evaluate ovarian and uterine perfusion in 790 infertile patients. STUDY DESIGN: Transvaginal color Doppler assessment of the ovarian and uterine circulation in infertile patients with benign pelvic lesions, uterine anomalies and ovarian or uterine dysfunction. RESULTS: Uterine anomalies were detected in 146 patients: 135 septate and 11 bicornute uteri. No alteration, in terms of resistance index (RI), was detected for main uterine arteries in patients with duplication anomalies of the uterus. Submucous fibroids were identified in 25 patients, while subserous leiomyoma were diagnosed in five patients. The mean RI for these lesions covered the value of 0.55 +/- 0.09. Endometrial polyps altered the endometrial perfusion in 26 infertile patients (RI = 0.48 +/- 0.06), while 11 avascular intrauterine synechiae were identified. Functional ovarian cysts were transitory present in 59 patients. The RI varied from 0.52 +/- 0.06 for follicular and 0.46 +/- 0.08 for corpus luteum cysts. Ovarian endometrioma were visualized in 78 infertile patients. Forty eight of them were vascularized at the level of the hilus, while 16 showed pericistic vascular location (RI ranged from 0.40 to 0.59). Dermoid cysts (n = 12) were mostly avascularized (75%), while polycystic ovaries demonstrated increased intraovarian vascularity in all the examined cases. The mean RI detected within the ovarian stroma was 0.52 +/- 0.06. In 11 patients premature menopause was predicted due to low volume of the ovary (< 2 cm3) and absence of the intraovarian vascularity. Hydrosalpynx or sactosalpynx were imaged in 154 patients. The RI varied from 0.44 in acute to 0.74 in chronic stage of the disease. CONCLUSION: Transvaginal color Doppler allows precise estimation of the functional state of the reproductive organs in infertile patients.

Evaluation Studies as Topic↗
PubMed1997

The assessment of normal and abnormal luteal function by transvaginal color Doppler sonography.

OBJECTIVE: To evaluate intraovarian resistance index (RI) in 47 healthy fertile volunteers with ovulatory cycles, 28 patients with luteal phase defect (LPD) and four patients with luteinized unruptured follicle (LUF Sy). STUDY DESIGN: Transvaginal color Doppler assessment of the follicular and corpus luteum blood flow and plasma progesterone (P) levels were obtained in each patient. RESULTS: Significantly higher intraovarian artery RI (< 0.001) was obtained for LPD group than for controls during the luteal phase. In the control group both follicular and corpus luteum RI were significantly lower (P < 0.001) on the dominant side, while in LPD group no difference (P > 0.05) between the sides occurred. Mean P levels were significantly lower (P < 0.001) in the LPD group (6.9 +/- 2.3 ng/ml) than in controls (24.1 +/- 11.4 ng/ml). In all the LPD patients histopathology revealed delayed endometrial pattern, while normal endometrial dating was found in all the evaluated patients form the control group (n = 15). In the patients with LUF Sy (n = 4) similar RI values were obtained in the follicular and corpus luteum phase. There was no difference between the sides in terms of the intraovarian RI, while subnormal values of P were obtained in all the examined patients (14.1 +/- 6.2 ng/ml). CONCLUSIONS: Transvaginal color Doppler may predict the function capacity of the corpus luteum.

Corpus Luteum↗
PubMed1997

Conflicting data on intervillous circulation in early pregnancy.

According to classic embryological textbooks intervillous circulation is established early in the first trimester. This process starts with trophoblastic invasion of the decidua in which proteolytic enzymes facilitate the penetration and erosion of the adjacent maternal capillaries with formation of the lacunae. After the lacunar or previllous stage trophoblast invades deeper portions of endometrium with belonging spiral arteries. This gradual process finishes with direct opening of the spiral arteries in the intervillous space under the fully developed placenta. This classic concept of establishment of the intervillous circulation was challenged in 1987 and 1988 by the experiments of HUSTIN and SHAAPS. The authors believed that blood flow in the intervillous space is absent in incompletely development before 12 weeks of gestation. After the introduction of the new generation of far more sensitive color Doppler devices in the last few years, our group and several others reported a positive finding of intervillous circulation during the first trimester of pregnancy.

Chorionic Villi↗
PubMed1997

Intervillous circulation in all three trimesters of normal pregnancy assessed by color Doppler.

Our cross-sectional study included 115 healthy pregnant women in gestational age between 7 and 24 weeks. The aim of the study was to compare resistance (RI) and pulsatility (PI) indices, peak systolic velocity (PSV), end-diastolic velocity, and temporal averaged maximum velocity (TAMV) of the spiral arteries and vessels within the intervillous space in all three trimesters of pregnancy. The impedance to blood flow within the intervillous space significantly decreased towards the mid-pregnancy (p < 0.01) and then remained stable. Blood flow velocities within the intervillous space expressed by PSV, EDV and TAMV increased significantly (p < 0.01) towards the mid-pregnancy. After reaching the plateau between 16 and 22 weeks of gestation, these parameters remained almost constant until the 36th gestational week. Near the term low-significant decrease of blood flow velocities was noted: for PSV and TAMV p < 0.07, and for EDV p < 0.05. A significant increase in continuous intervillous blood flow velocity was noted from the 11th week onward (28 +/- 12 vs. 36 +/- 12) until the 36th week of gestation (36 +/- 12 cm/s). The first report of the haemodynamic changes within the intervillous space during pregnancy may have implication in better understanding of the metabolical interchange between maternal and fetal side.

Chorionic Villi↗
PubMed1995

Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography.

OBJECTIVE: To evaluate the role of transvaginal color Doppler in differentiating uterine sarcoma from myoma. STUDY DESIGN: A group of 2010 women were examined by transvaginal color Doppler ultrasonography 1 day before planned hysterectomy. Ten cases with uterine sarcoma were analyzed with respect to their color Doppler sonographic patterns and compared with 150 normal and 1850 myomatous uteri. Analysis of variance was used to test the significance among the subgroups. RESULTS: All cases of uterine sarcoma (100%) revealed abnormal tumoral blood vessels. The mean resistance index (RI) of these vessels was 0.37 +/- 0.03, ranging from 0.32 to 0.42, which is statistically significantly lower than that of the normal and myomatous (P < 0.001) uteri. There was no significant difference between RI in the right and left uterine arteries in each separate group; however, there was a decline in these values from normal, through myomatous, to sarcomatous uteri. Using a cutoff point of 0.40 for RI we were able to distinguish between benign and malignant myometrial tumors with a sensitivity of 90.91%, specificity of 99.82%, positive predictive value of 71.43%, and negative predictive value of 99.96%. CONCLUSION: Color Doppler sonography has the potential to distinguish uterine sarcoma from benign uterine lesions.

Adolescent↗
PubMed1995

The value of transvaginal color Doppler in the assessment of pelvic inflammatory disease.

This study compares transvaginal color and pulsed Doppler (TVCD), laparoscopic and clinical findings in 102 women with proven pelvic inflammatory disease (PID). Seventy-two (72) of them had acute symptoms, 11 presented with chronic pelvic pain and 19 patients were infertility cases suspected of tubal etiology. Uterine sonographic findings were demonstrated in 72 patients (70.6%). Free fluid in the cul-de-sac was demonstrated in 39 (38.2%) patients. Ovarian enlargement as the only finding was demonstrated in 6 (5.9%) patients, 22 (21.6%) presented with tubular adnexal structure, while in 74 (72.5%) patients it was of a complex nature. Color flow was obtained in all 6 patients presenting with ovarian enlargement, in 12 (54.5%) of those presenting with tubular adnexal structure, and in 56 (75.7%) of those with complex adnexal mass. Ovarian morphology was clearly delineated from adnexal mass in 59 patients (55.9%). The ipsilateral ovarian flow was altered in 50 of them (84.7%). The mean resistance index (RI) in patients with acute symptoms was 0.53 +/- 0.09 (+/-SD). It significantly differed from those obtained in patients with chronic pelvic pain (RI = 0.71 +/- 0.07) and infertility cases (RI = 0.73 +/- 0.09). We concluded that transvaginal color Doppler is useful additional tool in diagnosis and treatment monitoring in patients with PID.

Abdominal Pain↗
PubMed1995

Ovarian senescence and its significance on uterine and ovarian perfusion.

OBJECTIVE: To measure the flow velocity of the ovarian, uterine, radial, and spiral arteries in different age groups. DESIGN: Serial measurements throughout the menstrual cycle in normal cycling women with documented fertility were compared with those in postmenopausal patients with and without hormone replacement therapy (HRT). SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Two hundred fifty patients were analyzed: 120 healthy fertile women, 85 postmenopausal patients, and 45 postmenopausal patients receiving HRT. INTERVENTIONS: All patients were examined by transvaginal color and pulsed Doppler. MAIN OUTCOME MEASURE: Changes in the resistance index of flow velocity waveforms of the ovarian, uterine, radial, and spiral arteries. RESULTS: Ovarian artery Doppler measurements in postmenopausal patients showed a significant difference when compared with the ovarian artery on the side containing dominant follicle or corpus luteum in healthy fertile group. Uterine and radial artery flow velocity analyses demonstrated significant positive correlations between the resistance index and years of menopause. In patients receiving HRT, a lowering effect occurred in the resistance index of the main uterine artery and its intramyometrial branches. Visualization of clear Doppler signals from the spiral arteries was possible in 30% of women who were menopausal for < 5 years. Increased vascular impedance was the typical finding in this vessel for this group of patients. The addition of HRT resulted in higher visualization rates of the spiral arteries and lowered resistance index values. CONCLUSIONS: There are changes in the flow velocity patterns of the ovarian, uterine, radial, and spiral arteries with age. The fact that the uterine artery resistance index does not change significantly in the first postmenopausal years strongly supports the thesis that the aging process initially affects the uterus less than the ovary. Furthermore, the uterine environment can be manipulated more easily during the menopausal years by proper hormonal stimulation.

Aging↗
PubMed1994

Scoring system for prediction of ovarian endometriosis based on transvaginal color and pulsed Doppler sonography.

OBJECTIVE: To develop a new noninvasive scoring system using clinical signs and symptoms, CA-125 levels, sonographic findings, and transvaginal color and pulsed Doppler parameters for preoperative recognition of ovarian endometriosis. DESIGN: A 5-year prospective study in patients undergoing laparotomy and laparoscopy. SETTING: Department of Obstetrics and Gynecology, University of Zagreb, Sveti Duh Hospital, Zagreb, Croatia. PATIENTS: Six hundred fifty-six benign and malignant adnexal masses, among which 103 were surgically proved to be ovarian endometriosis. INTERVENTIONS: All patients undergoing laparotomy and laparoscopy were examined by transvaginal ultrasonography with color Doppler imaging. Serum levels of CA-125 were measured the day before surgery. MAIN OUTCOME MEASURE: The total score was applied in all patients with adnexal masses. RESULTS: The scoring system proved to be very useful in distinguishing ovarian endometriosis from other benign and malignant ovarian lesions, with a sensitivity of 99.02% and a specificity of 99.64%, compared with morphological scoring system's sensitivity of 83.91% and specificity of 97.12%. CONCLUSION: The new noninvasive scoring system improves significantly the ability to discriminate between endometriosis and other benign and malignant ovarian entities.

Adult↗
PubMed1994

Vascularization of yolk sac and vitelline duct in normal pregnancies studied by transvaginal color and pulsed Doppler.

The yolk sac is an organ of increasingly recognized importance in the initial mechanisms of pregnancy maintenance and the early growth and welfare of the embryo. Having a complex protein secretion and an equally intricate ultrastructure, it is the primary source of blood and germ cells. This small and to date largely ignored structure may have a vital and interesting part to play in human embryonic development, which may be comparable to its proven evolutionary importance in other animals. The aim of our study was to assess the vascularity of the yolk sac and vitelline duct in 105 patients between the 6th and 10th weeks of gestation who were scheduled for termination of pregnancy for psychosocial reasons. The patients were divided in five subgroups depending on the duration of gestation. All of them had a normal developing pregnancy with no clinical symptoms of pathology (e.g. bleeding in early pregnancy). Gestational age was calculated from the first day of the last menstrual period and substantiated by crown-rump (CRL) measurements. After exploration of the gestational sac and embryo by transvaginal sonography, color Doppler was used to image the yolk sac and vitelline duct vascularity. The visualized vessels were analyzed with pulsed Doppler using the sample volume unit set of 1 mm. The assessment of obtained waveform signals was made by means of peak systolic Doppler shift (PSV) and pulsatility index (PI). The pulsatility index was calculated as a difference between peak systolic and end diastolic Doppler shift divided by the mean maximum velocity. At least 5 separate cardiac cycles were measured, and the mean value was calculated.(ABSTRACT TRUNCATED AT 250 WORDS)

Embryonic and Fetal Development↗