Laparoscopic management of the cornual pregnancy.

Traditional treatment of interstitial pregnancy includes cornual resection or hysterectomy by laparotomy, but advanced minimally invasive surgery allows successful endoscopic management. We report a case where interstitial pregnancy was successfully diagnosed by ultrasound and treated by laparoscopy. Patient had an unremarkable postoperative course. This case demonstrates that a laparoscopic approach toward cornual pregnancy is possible.

A multidisciplinary approach to the early detection of ovarian carcinoma: rationale, protocol design, and early results.

OBJECTIVE: This study was undertaken to determine the feasibility of currently available tests to detect ovarian cancer at a curable stage. By studying women at risk for the disease on the basis of their family histories of cancer, we hope to gain insight into the genetics and biologic characteristics of ovarian cancer. STUDY DESIGN: Asymptomatic women with a family history of cancer are interviewed by geneticists to obtain accurate pedigree and epidemiologic data. Screening tests including transvaginal ultrasonography, color Doppler imaging, CA 125 measurement, and other investigative biomarkers are performed between cycle days 3 and 8 and repeated biannually. RESULTS: A total of 597 women without symptoms were screened between July 1991 and June 1992. Cystic or complex adnexal masses were detected in 6.2% of patients. A pulsatile index value < 1.0 was measured in 80% of premenopausal patients and 24% of postmenopausal patients, whereas a resistance index value < 0.4 occurred in 12% of premenopausal and 3% of postmenopausal patients. A CA 125 level > 35 U/ml was found in 11.4% of the study participants. To date, one stage IA borderline ovarian tumor and one endometrial carcinoma have been found. CONCLUSIONS: Ovarian cancer screening needs to be investigated in a controlled fashion to determine means that will ultimately improve the survival from the disease.

The assessment of normal early pregnancy by transvaginal color Doppler ultrasonography.

Transvaginal color Doppler was performed in 198 volunteer pregnant women whose menstrual age ranged from the fifth to the twelfth week. In all patients an attempt was made to obtain signals from both uterine arteries, peritrophoblastic/retroplacental vessels, umbilical arteries, fetal aorta, intracranial vessels, and corpus luteum flow. With the combination of color and pulsed Doppler transvaginal sonography, detection of vascular structures was greatly facilitated and the amount of time for examination significantly reduced. Flow velocity waveforms were measured and results were analyzed by calculation of the Resistance Index. During the early stage of pregnancy, we were able to locate both uterine arteries in all cases and continuous diastolic shift signal was found. Flow in the peritrophoblastic/retroplacental area was observed with an overall success rate of 94%. Blood flow in the umbilical artery and fetal aorta was visualized by color Doppler starting from the seventh week. Intracranial blood flow could be visualized starting from the tenth week in some cases. Diastolic flow in these vessels was detectable starting from the twelfth week. Corpus luteum flow was found in 148 cases (75%) and the Resistance Index decreased as pregnancy progressed.

Transvaginal color Doppler in the assessment of abnormal early pregnancy.

The study groups comprised 61 pregnant women whose gestational age ranged from 7 to 12 weeks from the last menstrual period. All patients apparently had a normal developing pregnancy; there were no clinical symptoms of pathology e.g. bleeding in early pregnancy. Eighty-two patients with a clinically and ultrasonographically normal pregnancy whose gestational age ranged from 7 to 12 weeks, served as a control group. When the anatomical position of investigated area have been obtained clearly, pulsed wave Doppler sample volume was placed on the structures of interest: the both uterine arteries and intervillous space. There is no statistically significant difference between the Resistance Index (RI) in the left or right uterine artery (P greater than 0.01) and among investigated groups of patients (P greater than 0.01). The intervillous blood flow RI in the case of molar pregnancy was 0.38 with SD +/- 0.03; in blighted ovum 0.43 with SD +/- 0.03, and in missed abortion 0.43 with SD +/- 0.02. It should be stressed that in nine (31%) cases of blighted ova and in five (26%) cases of missed abortion, intervillous space flow could not be detected. In the control group, intervillous blood flow was always visualized and the mean RI was 0.45 with SD - 0.04. Statistical analysis showed significantly higher RI in control group in comparison with other groups of patients (P less than 0.01), and significantly lower RI in molar pregnancy in comparison with other groups of patients (P less than 0.01). There was no difference in RI between blighted ova and missed abortions (P greater than 0.01).

Tissue characterization by transvaginal colour Doppler for the evaluation of gynaecological tumours. 2. Clinical experiences.

Transvaginal colour Doppler was used to evaluate the blood flow patterns in pelvic vessels in a group of 315 patients including 168 with uterine tumours and 147 with adnexal masses. Neovascularization of malignant tumour tissue was successfully displayed by colour Doppler in the vases of endometrial and ovarian cancers but no abnormal blood supply was observed in the cases of early cervical cancers. A comparison between the characteristics of blood flow within benign and malignant lesions showed lower resistance index in cases of malignancy. The sensitivity, specifity, positive predictive value, negative predictive value and the diagnostic accuracy of this new method in the recognition of endometrial and ovarian cancers are higher than 95%. By the help of transvaginal colour Doppler (together with the classical methods as colposcopy, cytology etc.) it will be possible to establish of complex screening programmes for all types of gynaecological cancers.