Severe gastrointestinal tract bleeding in a two-month-old infant due to congenital intrahepatic arterioportal fistula.

A 2-month-old boy was referred for assessment of severe upper gastrointestinal tract bleeding and melena. On physical examination, a continuous murmur was heard over the right upper quadrant of the abdomen. A splenomegaly and dilated veins were also noted on the abdominal wall. Liver functions were normal. There was no history of trauma or jaundice. Doppler ultrasonography, magnetic resonance arteriography and angiography suggested the presence of an intrahepatic arteriovenous fistula between the phrenic artery and the portal vein. Management consisted of successful embolization by coiling of the phrenic artery. To our knowledge this is the first documented case report of a congenital fistula between the phrenic artery and the portal vein.

Endometrial wave-like activity in the non-pregnant uterus.

The non-pregnant uterus shows wave-like activity throughout the menstrual cycle. This uterine activity was first detected using intra-uterine pressure recordings. The use of ultrasound has made it possible to study the movements of the uterus in a non-invasive manner. Throughout the menstrual cycle, several wavelike activity patterns have been described; these patterns change throughout the menstrual cycle and are governed by steroid hormones. An adequate wave pattern seems to be related to successful reproduction in spontaneous cycles and assisted reproduction. Further insight into the phenomenon of endometrial wave-like activity might offer an opportunity to correct abnormal wave patterns and thereby improve pregnancy rates.

Endometrial wave direction switch and the outcome of in vitro fertilization.

OBJECTIVE: To describe endometrial wavelike activity, endometrial thickness and texture in IVF cycles, and to relate them to IVF outcome. To evaluate wave patterns on the day of hCG administration as a predictor of IVF outcome. DESIGN: Ultrasound study. SETTING: University hospital-based infertility clinic. PATIENT(S): Twenty-eight women undergoing IVF. INTERVENTION(S): Ultrasound examinations were performed at five fixed moments (start ovarian stimulation, hCG administration, ovum pickup (OPU), ET, and 7 days after hCG administration) and at three variable moments in the stimulation period in the cycle. The OPU was performed 2 days after hCG administration; ET was performed 2 or 3 days after that. MAIN OUTCOME MEASURE(S): Endometrial wave pattern, thickness, texture, IVF outcome. RESULT(S): Embryo transfer was performed in 22 cycles. In 73% of the cycles a wave direction switch (WDS) from fundus to cervix (FC) to cervix to fundus (CF) occurred before OPU. Eleven (50%) patients became pregnant. Significantly more FC waves persisted until hCG administration in the cycles in which the patients conceived. Endometrial thickness and texture were unrelated to IVF outcome. CONCLUSION(S): Endometrial wave pattern is associated with pregnancy in IVF. The persisting presence of FC waves until hCG administration (a late WDS) predicts a favorable IVF outcome.

Endometrial wavelike activity, endometrial thickness, and ultrasound texture in controlled ovarian hyperstimulation cycles.

OBJECTIVE: To describe endometrial wavelike activity, endometrial thickness, and texture in controlled ovarian hyperstimulation (COH) cycles. DESIGN: Prospective observational ultrasound study. SETTING: University hospital-based infertility clinic. PATIENT(S): Thirty-five COH cycles in 19 women with unexplained infertility. INTERVENTION(S): Transvaginal ultrasound examination was performed throughout COH cycles. Intrauterine insemination was performed after hCG administration. MAIN OUTCOME MEASURE(S): Endometrial wavelike activity, wave frequency, wave velocity, endometrial thickness, and endometrial texture. RESULT(S): Endometrial wavelike activity increased from menstruation to ovulation and decreased in the luteal phase. On day hCG+2, endometrial wave-like activity was observed in all cycles. Waves from cervix to fundus prevailed in the periovulatory phase. Endometrial wavelike activity was related significantly to endometrial thickness at the start of ovarian stimulation and in the luteal phase. Endometrial thickness increased throughout the cycle. Endometrial texture showed periovulatory a triple-line aspect. CONCLUSION(S): In COH cycles, endometrial wavelike activity is more pronounced than in spontaneous cycles. The number of follicles and endometrial wavelike activity were not correlated significantly. This is the first prospective study to provide longitudinal observational evidence that endometrial thickness increases throughout the COH cycle and that a triple line pattern develops.

Velocity of endometrial wavelike activity in spontaneous cycles.

OBJECTIVE: To analyze the velocity and wave intervals of endometrial wavelike activity in spontaneous menstrual cycles. DESIGN: Prospective observational ultrasound (US) evaluation of endometrial wavelike activity. SETTING: University hospital. MAIN OUTCOME MEASURE(S): Endometrial wavelike activity, wave velocity, wave intervals. PATIENT(S): Twenty-three menstrual cycles were evaluated by frequent US investigations in 16 healthy, regularly cycling female volunteers. INTERVENTION(S): Transvaginal US examination of endometrial wavelike activity. RESULT(S): Nineteen cycles proved to be ovulatory. Wave velocity and wave intervals were calculated in waves from fundus to cervix and in waves from cervix to fundus. The velocity of waves from fundus to cervix increased from the midfollicular phase to the late follicular phase. Waves from cervix to fundus showed their highest velocity in the periovulatory period. CONCLUSION(S): Velocity of endometrial wavelike activity reached a peak in the periovulatory phase, whereas the wave intervals were shortest in that phase.

Relation between endometrial wavelike activity and fecundability in spontaneous cycles.

OBJECTIVE: To determine whether endometrial activity is related to the occurrence of pregnancy in spontaneous menstrual cycles. DESIGN: Prospective observational ultrasound evaluation of endometrial activity during fertility screening cycles. SETTING: University hospital-based infertility clinic. PATIENT(S): Fifty-nine fertility screening cycles (ultrasound monitoring of follicle growth and ovulation, postcoital test, semen analysis, midluteal P, Chlamydia antibody determination, and tubal patency testing) were performed in 47 couples complaining of infertility. In 33 couples (37 cycles), no fertility impairing factors were found. Endometrial activity was analyzed in these cycles. INTERVENTION(S): Ultrasound examination was performed transvaginally throughout the cycle. MAIN OUTCOME MEASURE(S): Endometrial activity, wave pattern, pregnancy. RESULTS(S): Nine women conceived within the cycle studied. Conception cycles showed less-activity compared with nonconception cycles. Endometrial wavelike activity increased throughout the follicular phase and decreased after ovulation in conception and nonconception cycles. CONCLUSION(S): Endometrial activity is related to fecundability in a spontaneous cycle.

Subendometrial contractions in the nonpregnant uterus: an ultrasound study.

Endometrial wavelike activity was studied by ultrasound, throughout 19 ovulatory cycles in 16 healthy female volunteers. Analysis was focused on the presence of endometrial activity and the wave types. Five activity patterns were distinguished, which varied throughout the cycle. Endometrial activity was most striking during the periovulatory phase.

Endometrial wavelike movements during the menstrual cycle.

OBJECTIVE: To qualify and quantify endometrial waves in regularly cycling women. DESIGN: A prospective transvaginal ultrasound study was performed throughout 23 cycles of 16 healthy women. Wave type and wave frequency were evaluated. SETTING: Normal human volunteers in an academic research environment. PATIENTS: Sixteen healthy regularly cycling women. RESULTS: Of 23 cycles, 19 proved to be ovulatory. Five types of endometrial waves could be distinguished. Waves from cervix to fundus and opposing waves were seen predominantly periovulatorily. Waves from fundus to cervix were absent in the postovulatory phase. Endometrial wavelike activity was most pronounced in the periovulatory phase. CONCLUSIONS: Standardized qualification and quantification of endometrial waves, as described in this study, might shed new light on the underlying mechanisms in selected cases of hitherto unexplained subfertility.