Transabdominal chorionic villus sampling: experience at Maharaj Nakorn Chiang Mai Hospital.

OBJECTIVE: To describe the experience of transabdominal chorionic villus sampling (CVS) at Maharaj Nakorn Chiang Mai Hospital. MATERIAL AND METHOD: Between January 2004 and July 2006, 185 pregnant women chose to have CVS for prenatal diagnosis after counseling. Transabdominal CVS under ultrasound guidance was performed in all cases under local anesthesia using spinal needle 20-gauge with back and forth movement technique. The sample was immediately examined under a microscope to determine if the villi were obtained and to remove the decidua (maternal cells) from the villi. RESULTS: The mean gestational age was 12.25 +/- 1.05 weeks (range 10-20 weeks). The procedure was successful in all cases, 168 cases (90.9%) with one attempt. The indications for prenatal diagnosis included fetal risk for chromosomal abnormalities (110 cases; 59.46%), severe thalassemia syndrome (57 cases; 30.81%), both of them (17 cases; 9.19%) and for HLA typing in one case. The results could not be obtained in 11 cases (5.95%) due to laboratory failure. In the present study, abnormal chromosomes were detected in chorionic villi from 12 fetuses, including 45,X (3), trisomy 18 (3), trisomy 21 (2), trisomy 7 (1) and mosaicism (3). Additionally, 18 fetuses with severe thalassemia syndrome were identified; five homozygous beta-thalassemia, 11 beta-thalassemia/Hb E disease, and two homozygous alpha-thalassemia (Hb Bart's). The complications found in the present study included one case (0.54%) of fetal loss following the procedure and one case (0.54%) of vaginal bleeding. No case with limb reduction defect, infection, or rupture of membranes following the procedure was seen. CONCLUSIONS: Transabdominal CVS is a rather safe and reliable prenatal diagnostic technique. The fetal loss rate following the procedure in the present study was 0.54%. However operator' experience and skill in ultrasound-directed needle guidance procedure are essential.

A comparison of sonographic image quality between the examinations using gel and olive oil, as sound media.

OBJECTIVE: To compare the quality of real-time sonographic images obtained from the examinations using two different sound media, ultrasound gel and olive oil. MATERIAL AND METHOD: A randomized controlled trial was conducted on the study population recruited from the routine ultrasound service with written informed consent. Each patient underwent scan using both ultrasound gel and olive oil as sound media, but only one media at a time. During each patient examination, the first type of sound media was randomly used and then followed by the other media. The sonographic images of the same plane were recorded as video clips for each type of sound media. The quality of images were blindly evaluated by one experienced sonographer and the quality of ultrasound images was rated as 0 (very poor), 1 (poor), 2 (fair), and 3 (good), respectively. RESULTS: Of 346 cases (692 video clips), the image quality scores in ultrasound gel group and olive oil group were poor, fair, and good quality in 7, 182, and 157 and 9, 190, and 147 cases, respectively. The difference of quality scores between both groups was not statistically significant. (Chi square test; p = 0.687). CONCLUSION: The quality of images obtained from the scan using olive oil is similar to that using ultrasound gel. Therefore, the olive oil may be used as alternative sound media for ultrasound examination. Furthermore, it could possibly be a preferred media because of its lower cost, pleasant smell, and it facility of cleaning.

Mammographic changes related to different types of hormonal therapies.

OBJECTIVES: To determine the effects of different types of hormone therapies (HT) on mammographic breast density changes. MATERIAL AND METHOD: Between 1999 and 2002, mammograms obtained before and 12-18 months after different types of HT in 170 women were evaluated Estrogen alone (n = 66), or estrogen in cyclic (n = 59) or continuous (n = 45) combination with progesterone were used. The baseline mammographic density was classified according to the Breast Imaging Reporting and Data Systems (BI-RADS). The serial changes observed mammographically were categorized as follows; no change, minimal change (10-25% increased density), moderate change (26-50% increased density), and marked change (> 50% increased density). Results: Twelve (7%) of the women developed an increase in parenchymal density after HT: Mammographic changes were minimal change in five (2.9%) of the women, moderate change in four (2.3%), and marked change in three (1.8%). No mammographic change was observed in women receiving cyclic estrogen-progesterone. A greater percentage of women who had undergone continuous estrogen-progesterone therapy (22.2%, 10 of 45) demonstrated more change than those who had estrogen alone (3%, 2 of 66). The difference was statistically significant (p < 0.01). Conclusion: Changes of increased density after HT was seen in only 7% of mammograms and depended on the selected hormone regimen.