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ABSTRACT: An adequate endometrial receptivity is a crucial factor for embryo implantation. We describe endometrial morphology (endometrial appearance or pattern, endometrial thickness, volume, and delimitation), based on the concepts and possibilities of the new ultrasound modalities (3-dimensional/4-dimensional ultrasound, automatic volume calculation, virtual organ computer-aided analysis, tomographic ultrasound image, inverse mode, and 3-dimensional Doppler angiography) as markers of endometrial receptivity.
Ultrasound quarterly 03/2013; 29(1):3-20.
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ABSTRACT: The volume ultrasound technology software known as the HDlive technique represents an innovative tool, a step towards an even more realistic anatomical visualization of pelvic organ structures. HDlive can help improve physician-patient communication with the aid of life-like images and might prove useful in the field of assisted reproduction treatment. The clinical application of this novel ultrasound technology in assisted reproduction treatment deserves scientific evaluation.
Reproductive biomedicine online 12/2012; · 2.04 Impact Factor
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Ultrasound in Obstetrics and Gynecology 07/2011; 39(2):241-2. · 3.01 Impact Factor
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ABSTRACT: The purpose of our retrospective observational series was to determine whether the sonographic characteristics of fetal megacystic bladders can be used to reliably establish the most likely diagnosis in fetuses with this condition. The sonographic records of pregnant patients referred to our institutions over a 10-year period who were found on initial 2-dimensional sonography to be carrying fetuses with megacystis were examined for evidence of a keyhole sign, bladder thickness, amniotic fluid index, and fetal sex. When available, 3-/4-dimensional sonography, Doppler angiography, tomographic ultrasound imaging, virtual organ computer-aided analysis, and automatic volume calculation were used as part of the detailed fetal anatomic survey. Twenty fetuses with megacystis were identified. Seventeen were male; 2 were female; and 1 had ambiguous genitalia. All male fetuses with megacystis originally had a diagnosis of prune belly syndrome. The diagnosis for 10 male fetuses with a keyhole sign was changed to megacystis secondary to posterior urethral valves. The fetus with ambiguous genitalia had prune belly syndrome. One of the female fetuses had a diagnosis of urethral atresia, and the diagnosis for the other female fetus was megacystis-microcolon-intestinal hypoperistalsis syndrome. In conclusion, in fetuses with megacystic bladders, it is possible to distinguish between cases with prune belly syndrome, posterior urethral valves, urethral atresia, and megacystis-microcolon-intestinal hypoperistalsis syndrome by a detailed anatomic survey using 2- and 3-/4-dimensioinal sonographic techniques.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 06/2011; 30(6):833-41. · 1.25 Impact Factor
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ABSTRACT: The purpose of this series was to determine whether the use of different 3-dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero.
Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2-dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer-aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained.
Three-dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations.
Three-dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 02/2010; 29(2):281-5. · 1.25 Impact Factor
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ABSTRACT: To evaluate the hemostatic efficacy and handling of gelatin-thrombin matrix in abdominal myomectomy.
Prospective and randomized trial.
University teaching hospital.
Women (n = 50) with uterine fibroids with a uterine size equivalent to > or =16 weeks gestation.
Gelatin-thrombin matrix (FloSeal Matrix; Baxter Healthcare Corp., Fremont, CA) was delivered to the site of the uterine bleeding during myomectomy.
Patient age, parity, number of myomas, operative time, blood loss, transfusion, intraoperative and postoperative complications, and length of hospitalization were evaluated.
The average blood loss during surgery was 80 +/- 25.5 mL for the FloSeal group and 625 +/- 120.5 mL for the control group. Intraoperative blood transfusion was necessary in five patients from the control group. Postoperative blood loss was 25 +/- 5 mL for the FloSeal group and 250 +/- 75 mL for the control group. Length of the postoperative hospital stay was 2.5 +/- 1.2 days for FloSeal group and 4.5 +/- 1.3 for the control group. No major immediate or delayed complications were observed in either group.
Reductions in hemorrhage in FloSeal-treated women undergoing a myomectomy are encouraging, and provide evidence for the ability of gelatin-thrombin matrix to reduce blood loss when applied immediately and directly to bleeding uterine tissue.
Fertility and sterility 05/2009; 92(1):356-60. · 3.97 Impact Factor
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Fertility and sterility 03/2009; 91(4):1269-70. · 3.97 Impact Factor
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ABSTRACT: To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus.
Prospective, observational study.
University teaching hospital.
Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus.
Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus.
Differences in the mRNA expression of VEGF receptors between the endometrial samples of septate and normal uterus.
The mRNA expression of VEGF receptors, both KDR and Flt-1, was significantly lower in the endometrium lining the septum as compared with the endometrium covering the lateral wall of septate and normal uterus. Conversely, no differences were observed in mRNA expression in the soluble receptor sflt between the different endometrial samples studied.
The results suggest that a local defect of both VEGF transmembranous receptors (KDR and Flt-1) in the endometrium covering the septal area may be responsible for the clinical comportment of this müllerian anomaly.
Fertility and sterility 03/2009; 92(3):1085-90. · 3.97 Impact Factor
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ABSTRACT: Human endometrium is an active site of cytokine production and action. Among these cytokines, the interleukin-1 (IL-1) system seems to be relevant to the embryonic implantation process. We have previously reported the production of GnRH-I by human blastocyst, as well as the presence of GnRH-I receptor in human endometrium. This suggests a close interaction between the immune and endocrine systems through these cytokine mediators in embryonic implantation.
To test the relevance of this interaction during embryonic implantation, we investigated GnRH-I regulation of IL-1b and IL-1ra mRNA and protein expression in human endometrial stromal cells using quantitative competitive polymerase chain reaction and ELISA.
IL-1b mRNA and protein expression in cultured human endometrial stromal cells was significantly enhanced by GnRH-agonist in comparison to control groups. IL-1ra mRNA and protein was significantly decreased by GnRH-agonist in comparison to control groups. In contrast, the GnRH-antagonist ablated the regulatory effects of GnRH agonist in 1b and IL-1ra mRNA and protein levels in a dose-dependent manner.
In conclusion, these results suggest a possible close interaction between the immune and endocrine systems in human embryonic implantation through the classical neuropeptide hormone GnRH and its receptor.
Journal of Obstetrics and Gynaecology Research 09/2008; 34(4):464-72. · 0.94 Impact Factor
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ABSTRACT: We report a case of a congenital cystic adenomatoid malformation of the lung (CCAM). At 12 weeks of gestation, an echogenic lung associated to a hydrothorax was detected. Despite the results of the combined test that informed of a high risk of chromosomopathy, normal karyotype was confirmed after an amniocentesis. The three-dimensional ultrasound inversion mode depicted all the cysts within the fetal lungs as opaque areas that were seen concurrently together, which was compatible with CCAM. After parental counseling, the patient opted to terminate the pregnancy at 18 weeks. Pathological analysis of the lungs confirmed the diagnosis of a CCAM type II. The recent advent of the three-dimensional ultrasound inversion mode opens many diagnostic options until now unavailable or difficult to attain sonographically and therefore it may help us to increase the sonographic detection rates of congenital cystic adenomatoid malformation.
Journal of Obstetrics and Gynaecology Research 08/2008; 34(4 Pt 2):631-4. · 0.94 Impact Factor
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Prenatal Diagnosis 01/2008; 27(12):1158-60. · 2.11 Impact Factor
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Prenatal Diagnosis 07/2007; 27(6):585-6. · 2.11 Impact Factor
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ABSTRACT: Our aim was to compare the diagnostic capabilities of the multiplanar mode of 3D ultrasound (3D US) and MRI in the assessment of a fetal enlarged cisterna magna. Two fetuses showing an enlarged posterior fossa by conventional two-dimensional ultrasound at 24 and 29 weeks of pregnancy were assessed using both diagnostic methods. One fetus was found to have Dandy-Walker syndrome malformation. In the other, the syndrome was ruled out using both methods. Our results suggest that multiplanar 3D US is able to achieve similar results as does MRI when observing the fetal brain.
Journal of Perinatal Medicine 02/2007; 35(5):422-4. · 1.70 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 12/2006; 25(11):1499-502. · 1.25 Impact Factor
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ABSTRACT: Up to 1% of all pregnancies have clinically overt intra-amniotic bacterial infections, and an even larger percentage of pregnant women may be affected by silent infections. Although most pregnant women with overt intra-amniotic bacterial infection have experienced prolonged rupture of membranes (PROM), symptomatic and most silent nonviral intra-amniotic infections may occur with intact membranes. The etiology of intra-amniotic infection after PROM is almost always polymicrobial and consists of genital tract pathogens, such as group B streptococci, Chlamydia trachomatis, Neisseria gonorrhoeae, mycoplasmas, aerobic Gram-negative bacilli, such as the coliforms, and facultative and anaerobic endogenous organisms, such as peptococci, peptostreptococci, and Bacteroides species. These organisms gain access to the uterine cavity by the ascending route. Organisms such as Treponema pallidum, Listeria monocytogenes, Toxoplasma gondii, trypanosomes, and plasmodia are capable of gaining access to the amniotic cavity by transplacental hematogenous spread, and cause devastating fetal infections. Symptomatic intra-amniotic infection is usually a diagnosis of exclusion. Diagnostic criteria based on both clinical and laboratory findings lack sensitivity and are nonspecific. It is difficult to obtain uncontaminated intra-amniotic samples, especially when there is PROM. The problem is even greater with silent infections. In most cases, fetal infection is suspected after an unexplained and unexpected adverse outcome. Maternal morbidity is increased with intra-amniotic infection; although maternal mortality is extremely rare in developed countries, this is not the case in societies where pregnant women have limited or no access to medical care. Although infected women who are treated early and aggressively with wide-spectrum antibiotics do well, more than 10% of these women develop bacteremia and up to half of them will require cesarean delivery because of poor uterine contractions and arrest of labor. The overwhelming majority of term neonates exposed to intrauterine infection after PROM do well, but up to 30% of these neonates require treatment of neonatal pneumonia or bacteremia. Outcomes for preterm neonates or for neonates who experienced silent fetal infections are more severe. Morbidity and mortality rates in these cases are high, and survivors may have long-term devastating sequelae. The ability to identify ultrasound markers of fetal infection will help clinicians identify etiologic agents with greater accuracy and correlate these infections with specific antepartum and postpartum syndromes. The recognition of markers of intrauterine infection will also reduce unexpected adverse outcomes that result from undiagnosed fetal infections.
Ultrasound Quarterly 07/2006; 22(2):137-51. · 0.95 Impact Factor
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ABSTRACT: We describe a fetus with androgen insensitivity syndrome diagnosed at 16 weeks' gestation with two-dimensional (2D) and four-dimensional (4D) sonography and karyotype analysis in a 37-year-old pregnant woman. Two-dimensional (2D) sonography revealed a female phenotype. Karyotype analysis revealed an unremarkable 46,XY chromosomal complement. Repeat 4D sonography confirmed a female phenotype with edematous labia majora, consistent with androgen insensitivity syndrome.
Journal of Clinical Ultrasound 02/2006; 34(1):30-2. · 0.81 Impact Factor
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ABSTRACT: Diagnosis of fetal infection has depended on identification of pathogens by means of microbiological cultures, immunologic techniques, and special molecular biology techniques that can identify organisms known or suspected of being associated with adverse outcomes of pregnancy. Rubella, cytomegalovirus (CMV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV), for example, are capable of gaining access to the amniotic cavity and producing fetal infection, even when amniotic membranes are intact. Intrauterine invasion by viruses can be associated with maternal symptoms of infection or can be completely silent. In many instances extensive fetal compromise with irreversible structural damage or fetal death will have occurred by the time infection is confirmed by culture or other histopathological methods. The evidence of fetal infection may be as subtle as nascent intrauterine growth restriction (IUGR), mildly inappropriate calcification of fetal organs, placenta, cord, and membranes, and failure to adequately develop fetal fat reserves. The evidence of infection may be as dramatic as obvious fetal malformation, severe central nervous system structural damage, or fetal death. Sonography is capable of detecting most of the grave alterations and some of the subtle effects that are typical of fetal infection.
Ultrasound Quarterly 01/2006; 21(4):295-308. · 0.95 Impact Factor
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Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 07/2004; 23(6):877-81. · 1.25 Impact Factor
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ABSTRACT: The aim of this study was to evaluate and compare the diagnostic capabilities of 2-dimensional (2D) and 3-dimensional (3D) sonography for the study of conjoined twins.
Four pregnant women with an initial 2D sonographic diagnosis of conjoined twins were examined with color Doppler sonography, 3D multiplanar sonography, and orthogonal plane imaging and 3D surface rendering.
All 4 cases of conjoined twins were initially diagnosed with either transvaginal or transabdominal 2D sonography. 3D sonography afforded more realistic views and demonstrated more clearly the linking areas and surface anomalies, but 2D and color Doppler sonography provided more definitive and specific information about shared organs.
Although 2D sonography is the primary modality for diagnosing and evaluating conjoined twins, color Doppler and 3D sonography can sometimes provide additional information that assists in the clinical management of these twins. 3D sonography also provides images that are easier for parents to understand, which can help them with decision making.
Journal of Clinical Ultrasound 03/2002; 30(2):68-75. · 0.81 Impact Factor
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ABSTRACT: Fetal edema was recognized in the past as a complication of alloimmune disease. More recently, fetal edema is frequently seen in conditions that cause non-immune fetal hydrops with increased soft tissue thickness. Classically there is a halo pattern around fetal head, neck, thorax, and abdomen. Fetal edema is associated with karyotype abnormalities, with multiple congenital anomalies, and with certain fetal infections like parvovirus B19 that cause severe fetal anemia. In the present case there was no evidence of infection or karyotype abnormality, but there was hypoplasia of umbilical cord vessels, pulmonary hypoplasia, and pericardial effusion. The etiology of fetal hydrops may remain unknown in up to 30% of cases.
Journal of Perinatal Medicine 02/2002; 30(1):105-10. · 1.70 Impact Factor
