Transvaginal color and pulsed Doppler sonography of the endometrium: a possible role in reducing the number of dilatation and curettage procedures.

The objectives of the study were to establish color and pulsed Doppler sonographic characteristics of uterine vascularity in postmenopausal patients with pathologic endometrium in order to reduce the number of unnecessary diagnostic dilatation and curettage procedures. The prospective study involved 42 postmenopausal patients who were examined, prior to dilatation and curettage operation, with transvaginal color and pulsed Doppler sonography. Twenty patients had symptoms such as vaginal bleeding or clinically enlarged uterus and 22 postmenopausal women, from our screening group, were asymptomatic. Endometrial thickness (cut-off value of 8 mm), rates of visualization, and the density of uterine, myometrial (peritumoral) and endometrial (intratumoral) vessels were used, along with pulsatility and resistive indices of these vessels, to assess and correlate with endometrium pathology. Endometrial thickness was greater than 8 mm in all cases of endometrial carcinoma (14 of 14 cases), endometrial hyperplasia (eight of eight cases), and one endometrial polyp. In all cases of uterine myoma (nine cases) and in asymptomatic controls (11 subjects) the endometrium thickness was below 8 mm. Percentage of visualization of myometrial and endometrial vessels in cases of endometrial carcinoma was 93% and 43% respectively, which was significantly higher than for cases with benign endometrium (P < 0.05). RI and PI values of these studied vessels of endometrial carcinoma were significantly lower than those for endometrial hyperplasia (P < 0.05). In 80% of cases of endometrial carcinoma, dense vascularity was found in the myometrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

The characterization of flow signals from tubal and ovarian arteries using intraoperative continuous wave Doppler.

Ovarian vascular Doppler is a promising screening test for early ovarian cancer detection. However, disagreements on flow indices used, flow signal shapes and ovarian vessel localization cause continuing controversy. We aimed at clarifying some of this confusion by directly measuring the adnexal arterial blood flow during laparotomy. A 10-MHz continuous Doppler probe was used to examine adnexal vessels in 24 patients undergoing laparotomy for benign gynecological pathology. Resistance (RI) and pulsatility (PI) indices were calculated for each vessel and the shape of the flow signals was noted. The tubal arteries showed a low-velocity flow pattern with relatively high end-diastolic flow when compared to the ovarian artery signals obtained from the infundibulopelvic ligament.The mean RIs for the tubal artery and ovarian artery in the infundibulopelvic ligament were 0.59 +/- 0.02 and 0.73 +/- 0.02, respectively. The mean PIs for the tubal and ovarian artery in the infundibulopelvic ligament were 1.11 +/- 0.09 and 1.53 +/- 0.1, respectively. The tubal artery showed a significantly lower RI and PI when compared to the ipsilateral ovarian artery at the infundibulopelvic ligament (p < 0.001 and p = 0.002, respectively) and its hilar branches (p = 0.03 for RI and p = 0.03 for PI). We conclude that tubal artery flow signals, which are measured directly for the first time in this study, are characteristic and are distinct from the ovarian artery signals. Tubal artery signals might be erroneously picked up during transvaginal color Doppler sonography of the ovaries, especially in the presence of conditions causing a decreased impedance to blood flow in the pelvis, such as ovarian tumors. Recognizing the flow signal from the tubal artery may help in differentiating ovarian and tubal vessels detected during color Doppler sonography.

Nurses' beliefs and attitudes toward visiting in adult critical care settings.

OBJECTIVE: To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. DESIGN: Both interviews and questionnaires were used to gather data on nurses' attitudes and beliefs about visiting and open visiting according to the format of Ajzen and Fishbein's Theory of Reasoned Action. SETTING: Five Utah intensive care units and three Ohio intensive care units. SAMPLE: Critical care nurses in Utah (N = 29) and Ohio (N = 41) were interviewed to assess their beliefs about the effects of visiting on patients, families, nurses and nursing care delivery. RESULTS: Nurses believed the consequence of visiting was more positive for the patient from a psychological perspective than from a physiological perspective but that the effects might differ depending on the patient, the visitor and the circumstances. They believed that visiting had negative consequences for families, because they became exhausted, and that visiting was disruptive for nursing care delivery. Their attitudes about effects of visiting on nursing staff were consistently more negative than were attitudes about the effects on the patient and the family. CONCLUSION: To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.

Clinical assessment of gestational age: a comparison of two methods.

The ratio of fundal height (FH) to maternal abdominal length (MAL) was defined as percentage of maternal abdominal length (PMAL) and compared to FH alone in 100 consecutive uncomplicated pregnancies from the 18th week of gestation to delivery at term. Reference graphs for fetal growth evaluation were developed using these two clinical methods. The predictive value of each technique was assessed by comparing gestational age estimates in 29 additional patients at various gestational ages. The correlation coefficient between the known gestational ages and estimates by the PMAL method was .86, and between known gestational ages and estimates by the FH method, .94. Twenty more patients were evaluated by three obstetricians in a double-blind fashion to determine gestational ages by each technique. The average deviation from the real gestational age varied from 2.07 to 3.14 weeks using the FH method, and from 2.82 to 3.97 weeks using the PMAL graph. It was concluded that FH measurement correlates better with gestational age than its ratio to the MAL.

Chondrosarcoma of the uterus.

Chondrosarcoma of the uterus is a rare tumor. The clinical and pathological features of a recent case are presented and the histogenesis, treatment, and prognosis of the heterologous sarcomas are discussed. The authors favor the theory of totipotential endometrial stromal cells for the histogenesis, and suggest that radiotherapy and/or chemotherapy continue to be used in addition to total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Pelvic relaxation as a complication of the radical vulvectomy.

Attention is drawn to relaxation of the pelvic viscera, one of the remote complications of the surgical procedure employed for cure in invasive carcinoma of the vulva. Though seldom discussed in the literature, this problem complicated 17% of the 58 radical vulvectomy procedures in this series. Justification is discussed for the performance of reconstructive or preventive surgical procedures during the primary operation.