Uterine hyperperistalsis and dysperistalsis as dysfunctions of the mechanism of rapid sperm transport in patients with endometriosis and infertility.

Women suffering from infertility in association with mostly mild endometriosis were subjected to vaginal sonography of uterine peristalsis during the menstrual period, the early, mid- and late follicular phases, and the mid-luteal phase of the menstrual cycle. The data obtained were compared with those of healthy controls. Women with endometriosis displayed a marked uterine hyperperistalsis that differed significantly from the peristalsis of the controls during the early and mid-follicular and mid-luteal phases. During the late follicular phase of the cycle, uterine peristalsis in women with endometriosis became dysperistaltic, arrhythmic and convulsive in character, while in controls peristalsis continued to show long and regular cervico-fundal contractions. Hysterosalpingoscintigraphy during the early, mid- and late follicular phases revealed that hyperperistalsis in the early and mid-follicular phases of patients with endometriosis resulted in a dramatic increase in the transport of inert particles from the vaginal depot, through the uterus into the tubes and also into the peritoneal cavity. During the late follicular phase of the cycle, the dysperistalsis observed in women with endometriosis resulted in a dramatic reduction of uterine transport capacity in comparison with the healthy controls. We consider uterine hyperperistalsis to be the mechanical cause of endometriosis rather than retrograde menstruation. Dysperistalsis in the late follicular phase of patients with endometriosis may compromise rapid sperm transport. Uterine hyperperistalsis and dysperistalsis are considered to be responsible for both reduced fertility and the development of endometriosis.

The dynamics of rapid sperm transport through the female genital tract: evidence from vaginal sonography of uterine peristalsis and hysterosalpingoscintigraphy.

Vaginal ultrasonography of uterine peristalsis during the follicular phase of the menstrual cycle demonstrates an increasing frequency and intensity of subendometrial and myometrial peristaltic waves as the follicular phase progresses. During this time the numbers of contraction waves with a fundo-cervical direction decrease considerably in favour of waves of contraction with a cervico-fundal direction. There is evidence that rapid sperm transport through the female genital tract is passive and is provided by these uterine contractions. Using hysterosalpingoscintigraphy, rapid sperm transport was studied by placing technetium-labelled albumin macrospheres of sperm size at the external os of the uterine cervix and following their path through the female genital tract. Ascension of the macrospheres occurred immediately following deposition at the external os of the cervix. As early as 1 min thereafter, the macrospheres had reached the intramural and isthmical part of the tube. Quantitatively, the extent of ascension increased with progression of the follicular phase. While only a few macrospheres entered the uterine cavity and even fewer the tubes during the early follicular phase, the proportion of macrospheres that entered the uterine cavity increased dramatically during the mid-follicular phase despite continuing limited entry into the tube. During the late follicular phase there was considerable ascension of the macrospheres which was directed preferentially into the tube ipsilateral to the dominant follicle. These data indicate that rapid transport of the spermatozoa through the female genital tract is under the endocrine control of the dominant follicle, ensuring the preferential accumulation of spermatozoa at the site of fertilization.

[Dynamic cranial CT in ischemic cerebral lesions]. / Dynamische Schädel-CT bei ischämischen Grosshirnläsionen.

58 patients with recent transient or permanent neurologic deficits of with proven carotid stenoses were examined by dynamic CT at the level of the internal capsule. In the presence of cerebral infarcts there was marked delay in the time/density curve with reduced peaks. Abnormal perfusion could be demonstrated by early examinations before definite morphological changes were seen. With transient ischaemic attacks there were no significant changes in perfusion; in the presence of carotid stenoses the results were variable. The perfusion abnormalities in the hemispheres shown by dynamic cranial CT could be confirmed to some extent by 99mTc-HMPAO-SPECT.

Gaps and contract: evaluating the diffusion of new information. Part II. The measurement of the strategy.

This article is the second of a two-part series describing "gaps and contract," a strategy that provides nurses with a mechanism to transfer knowledge from theory into practice in a measurable format. Two universities under contract from the Pennsylvania state cancer plan used this strategy to evaluate the effectiveness of a cancer continuing education program. Two hundred seventy-four (274) contracts from one setting and 205 from a second setting are described. Recommendations for using this strategy to measure the efficacy of cancer continuing education programs are included.

[Ganglioneuroma of the pelvis accompanying pregnancy]. / Ganglioneurom des Beckens bei gleichzeitiger Schwangerschaft.

Ganglioneuroma is an uncommon benign tumor of the sympathetic nervous system. In most cases it originates from the thoracic or lumbar portion of the gangliated cord or from the medulla of the suprarenal glands. It is the differentiated form of malignant neuroblastoma. The tumor often manifests itself in young adults by displacement of the surrounding structures. In the case presented the special diagnostic problems of locating the tumor in the pelvis in early pregnancy are discussed.

[The current situation of radiologic diagnosis of blood vessels]. / Die aktuelle Situation der radiologischen Gefässdiagnostik.

The current situation with regard to vascular diagnostics in West Germany is analyzed on the basis of the results of a survey of large non-university institutes of radiodiagnostics. The operative equipment present is generally appraised as being adequate. However, equipment for the performance of digital subtraction angiography must be available. The importance of the intravenous technique is clearly diminishing. In some cases, large-format angiograms are completely dispensed with. The frequency of angiography is greatly decreasing. The expenditure of time and effort for the individual investigation has become greater, so that the angiographic equipment and rooms are used to a much greater extent in terms of time. A fairly uniform observation was that about 60% of all arteriographies are necessary because of sclerotic vascular conditions (AOD). These are often combined with interventional measures. The arteriographies are mainly carried out in the lower limbs (50-70%). The remainder is distributed in thoracic and, in particular, abdominal angiographies, among which the renovasographies still predominate. Numerous leg phlebographies are carried out everywhere and account for 85-95% of all venographic investigations. There has been a great decline in lymphographies throughout Germany.

[The value of the acetazolamide stimulation test with 99mTc-HMPAO-SPECT in reversible cerebrovascular insufficiency]. / Wertigkeit des Acetazolamid-Stimulationstestes mit der 99mTc-HMPAO-SPECT bei reversibler zerebrovaskulärer Insuffizienz (CVI).

Regional cerebral blood flow reduction was measured in 84 patients with CVI using 99mTc-HMPAO-SPECT. 53 patients received 1 g acetazolamide to evaluate cerebrovascular reserve capacity. Differentiating between hemispheric (87%) and vertebrobasilar ischaemia (64%) revealed markedly increased sensitivity for the provocative test with acetazolamide. In 62% of high grade but asymptomatic carotid stenoses a haemodynamic effect was demonstrated with acetazolamide and thereby the indication for surgery was supported.

[Problems in recognizing recurrences of craniocervical malignancies in CT]. / Probleme der Rezidiverkennung kraniozervikaler Malignome im CT.

A retrospective study was carried out involving 39 patients with malignant tumours of the head and neck in order to differentiate by CT changes due to local tumour or lymph node recurrences and various post-operative or post-irradiation changes. In these patients, two or more CT examinations of the neck were available, derived from a fourth generation scanner. The suspected lesions were classified according to their type and the appearances correlated with the treatment and clinical findings. There was frequent overlap between the appearances of benign and malignant changes, so that in individual cases a definite decision often proved impossible.

Cranial CT artifacts and gantry angulation.

Computed tomographic investigation of the brain is frequently accomplished by scanning parallel to the canthomeatal line. In these scans, evaluation of the brain stem and neighboring structures is often compromised by streak artifacts from bone-induced beam hardening. These artifacts may be reduced by introducing a change in gantry angulation. Results from a phantom study as well as from a clinical trial offer evidence that may be helpful in assessing different scanning planes. An inclination of 5 degrees below Reid baseline is suggested to minimize the interpetrous artifact. Variations in slice thickness and exposure parameters do not appear to affect significantly this typical posterior fossa artifact.

[Outpatient transbrachial arterial DSA using a 4F catheter for the clarification of extracranial vascular processes]. / Ambulante transbrachiale arterielle DSA mit 4-F-Kathetern zur Abklärung extrakranieller Gefässprozesse.

Experience with intravenous digital subtraction angiography (DSA) has proven disappointing in the outpatient evaluation of cerebrovascular disease. Variations in cardiac output, vessel superimposition, patient motion and poor vascular opacification frequently combine to produce nondiagnostic examinations. To assess the safety of nonselective intra-arterial DSA performed from a brachial artery approach, the complications of 103 examinations, most of which (85%) were performed on outpatients, were prospectively studied. The injection of contrast material into the aorta was made through a 4F multiple side-hole pigtail catheter, inserted percutaneously from the brachial artery. Images were good or excellent in nearly all cases. No permanent neurovascular complications or local artery complications such as thrombosis requiring surgery were encountered and only a few minor complications occurred. We believe that transbrachial intraarterial DSA is a safe, simple and well-tolerated out-patient procedure that can yield reliable, definitive, and complete cerebrovascular studies in nearly all patients referred for the examination.

[The computed tomography of colorectal tumors with water as the contrast medium]. / Computertomographie kolorektaler Tumoren mit Wasser als Kontrastmittel.

The diagnosis of colorectal carcinoma is based on double-contrast barium enema and endoscopy. However, in contrast to computed tomography (CT), these modalities do not permit a precise preoperative prediction wether a tumour is limited to the bowel wall or has spread into surrounding tissue. To improve the detection of colorectal neoplasms by CT we prospectively studied the use of intrarectally administered water for CT scan in 16 patients with colorectal cancer proved by barium enema and endoscopy. The water repletion technique allowed an improved depiction of the large bowel wall, and the primary tumour was demonstrated by CT in all cases. Furthermore the use of water prevented artifacts which was helpful in the evaluation of the liver for suspected metastases.

[Methodologic optimization of computerized tomography diagnosis of the large intestine]. / Methodische Optimierung der computertomographischen Dickdarmdiagnostik.

Examination of the intestine by computed tomography can supply additional information on diseases of the intestinal wall. However, the successful interpretation of the bowel wall by CT requires a special technique by which normal structures are opacified, identified and not mistaken for abnormal masses. The rectal administration of water improves the visualisation of the bowel wall and the diagnostic accuracy. This safe, reliable and acceptable method for opacifying the colon and rectum is described. Its value is demonstrated by means of normal and pathological examples.