Modification of the hand-held Vscan ultrasound and verification of its performance for transvaginal applications.

PURPOSE: The purpose of this work was to validate a new clinical obstetrics and gynecology (OB-GYN) application for a hand-held ultrasound (US) device. We modified the smallest hand-held device on the market and tested the system for transvaginal (TV) use. This device was originally conceived for abdominal scanning only. METHODS: The validation involved 80 successive patients examined by the same operator: 25 obstetric and 55 gynecologic cases. US examination was performed transvaginally with two US systems: the hand-held Vscan (General Electrics; GE Vingmed Ultrasound; Norway) for which an intravaginal gadget TTGP-2010® (Troyano transvaginal gadget probe) was designed, and the Voluson 730 Expert (multifrequency transvaginal ultrasound of 3-9MHz; GE Healthcare, Milwaukee, WI, USA). We performed the same measurements with both US systems in order to confirm whether or not their diagnostic capability was similar. Quantitative difference in measurements between the systems was assessed, as well as the overall diagnostic detection rate and suitability for telemedicine. RESULTS: Regarding lesion visibility with Vscan, optimal distance was 8-16cm depending on the examination type, and the total detection rate was 98.7%. The exception was an ovarian endometrioma, diagnosed as a follicular cyst using the hand-held device. Assessment of reproducibility in 180 measurements showed that the measurements obtained with Vscan were 0.3-0.4cm lower than those obtained with the high resolution US device (Voluson 730 Expert). Nevertheless, Pearson's correlation coefficient was high for biparietal diameter (0.72) and gynecological (GYN) (0.99) measurements, and for overall correlation (0.997). Image transport on USB and SD-flash cards proved convenient for telemedicine. CONCLUSIONS: A novel TV application of a hand-held US device is demonstrated for OB-GYN. Heart, abdominal and obstetrics presets of the Vscan together with color-Doppler enable a detection capability comparable to that of a high-definition US device. The lower values of the measurements obtained by the hand-held device (by 0.3-0.4cm) must be taken into account, although they have no effect on its diagnostic capability.

Evolución desfavorable en la perfusión arterial retrógrada entre gemelos / Unfavorable evolution of twin reversed arterial perfusion

Se presenta un caso de perfusión arterial retrógrada entre gemelos (secuencia TRAP), caracterizado por la coexistencia de un feto normal (donante) y un feto acardio (receptor).El diagnóstico precoz: (11.ª semana) permitió controlar, según progresaba la gestación el estado hemodinámico del feto donante, identificar los signos sugerentes de insuficiencia cardíaca y realizar la oclusión por láser vía fetoscopia del cordón umbilical del feto acardio (18.ª semana). A la 21ª. semana se produce la muerte del feto donante. El caso ilustra la importancia del diagnóstico precoz y del control hemodinámico mediante flujometría doppler para identificar la descompensación cardíaca del feto sano y realizar su tratamiento. (AU)