The Role of 3-Dimensional Power Doppler Imaging in the Assessment of Ovarian Teratoma in Pregnancy: A Case Report

Background. Conventional sonography is the primary imaging tool for these pregnant women who present with an ovarian teratoma. In some cases, however, sonography diagnosis is difficult. We report a case of ovarian teratoma during pregnancy diagnosed by three-dimensional Power Doppler. The cyst was removed via laparotomy without fetal or maternal complications. Three-dimensional ultrasound with multiplanar view can better discriminate a benign ovarian teratoma from complex ovarian lesions or malignant tumors. Its role is significant especially during pregnancy as it may assist in determining which patients are requiring surgery and which are not. The results of three-dimensional sonography and magnetic resonance (MR) were equal but the role of MR imaging is limited in early pregnancy. Conclusions. Three-dimensional technique is a reliable diagnostic modality for preoperative assessment of an ovarian teratoma as it can be performed during the first trimester of pregnancy

The Contribution of Three-Dimensional Power Doppler Imaging in the Preoperative Assessment of Breast Tumors: A Preliminary Report

Purpose. The aim of this study was to determine the value of 3D and 3D Power Doppler sonography in the detection of tumor malignancy in breast lesions and to find new diagnostic criteria for differential diagnosis. Methods. One hundred and twenty five women with clinically or mammographically suspicious findings were referred for 3D Power Doppler ultrasound prior to surgery. Histological diagnosis was conducted after surgery and compared with ultrasound findings. Sonographic criteria used for breast cancer diagnosis were based on a system that included morphological characteristics and criteria of the vascular pattern of a breast mass by Power Doppler imaging. Results. Seventy-two lesions were histopathologically diagnosed as benign and 53 tumors as malignant. Three-dimensional ultrasound identified 49 out of 53 histologically confirmed breast cancers resulting in a sensitivity of 92.4% and a specificity of 86.1% in diagnosing breast malignancy (PPV: 0.83, NPV:0.94). Conclusions. 3D ultrasonography is a valuable tool in identifying preoperatively the possibility of a tumor to be malignant

Fournier's gangrene in a patient after third-degree burns: a case report

<p>Abstract</p> <p>Introduction</p> <p>Fournier's gangrene is characterized by tissue ischemia leading to rapidly progressing necrotizing fasciitis.</p> <p>Case presentation</p> <p>We present the case of a patient with Fournier's gangrene after third-degree burns. Clinical manifestations, laboratory results and treatment options are discussed.</p> <p>Conclusion</p> <p>Fournier's gangrene is a surgical emergency. Although it can be lethal, it is still a challenging situation in the field of surgical infections.</p

Role of the combined use of power doppler 3-D and 3-D power doppler in the prognosis of ovarian tumors

Objective: To determine the role of 3-Dimensional Ultrasound (3-D) and Power Doppler (3-DPD) in the diagnosis of ovarian tumors and to examine the diagnostic accuracy of this new ultrasonographic technique in the detection of ovarian cancer. Methods: A preoperative analysis by 3-D and 3-DPD was performed between November 2003 and November 2006 of 318 women referred for the evaluation of a unilateral ovarian mass within the first Department of Obstetrics and Gynecology, University of Athens, in Alexandra Hospital. The age of the women studied was 47,418,8 years with a range (18-72 years). Three dimensional ultrasonographic method is a new diagnostic technique that provides precise and additional information of the region of interest by the rotation of the mechanical transducer through 360ο. Multiple sections of the ovarian tumor, rotation in the three axis (x, y, z), translation and reconstruction of (3-D) plastic images allow more meticulous and detailed evaluation, especially when modes used. Comprehensive (3-D) display allows interactive qualitative and quantitative analysis of the tumor microcirculation in three dimensions. In the present study, were analyzed sonomorphological criteria (wall structure, shadowing, septa 6) was associated with malignant histopathological types, with older women (54,7±10,5 years) with low social economical level (p=0,0034), with family history (p=0,999), with more than two coffees per day, with a history of breast cancer (p=0,010) and with hypertension (p=0,017). It has also to be reported that was a statistical significance between clinical symptoms and the high score of 3-D ultrasonographic criteria (p6), indicative of ovarian malignancy (p0,027), the probability of metastatic disease and the grade (borderline correlation: p=0,078). Conclusions: Even if color transvaginal ultrasonographic method has been established as a worthy and effective technique in the estimation of ovarian neoplasms has the disadvantage not to view the ovarian lesion entirely. On the contrary, 3-D sonographic analysis has the advantage of precise location, and measurement of ovarian tumor and allows multiplanar presentation of the capsule infiltration for the meticulous estimation of the ovarian lesion and at last, 3-D imaging shows abnormalities of neovascularization vessels with small diameter (<1mm) for the study of ovarian’s tumor microcirculation. The advantages, of the combined use of 3-D and 3-DPD are: 1. Objective diagnosis of ovarian neoplasms and discrimination of them in benign-malignant in order to reduce false negative and false positive results. 2. The contribution of this ultrasonographic method in the diagnosis of early stage I ovarian cancer. 3. The reduction of examination’s time and patient’s discomfort. Three dimensional ultrasound is a new emerging technology with a high level of diagnostic accuracy and main purpose the significant reduction of morbidity and mortality of ovarian cancer.Σκοπός: Να καθορισθεί ο ρόλος της τρισδιάστατης 3-D και Power Doppler (3-DPD) υπερηχογραφίας στην διάγνωση των ωοθηκικών όγκων και να διερευνηθεί η διαγνωστική ακρίβεια της νέας αυτής υπερηχογραφικής μεθόδου στην ανίχνευση καρκίνου των ωοθηκών. Υλικό-Μέθοδοι: Στην Α΄ Μαιευτική και Γυναικολογική Κλινική του Πανεπιστημίου Αθηνών του Νοσοκομείου «Αλεξάνδρα», από το Νοέμβριο του 2003 έως και το Νοέμβριο του 2006, έλαβε χώρα μελέτη προεγχειρητικής εκτίμησης 318 γυναικών με μονόπλευρη ωοθηκική μάζα, ηλικίας 47,4±13,8 έτη (18-72 έτη), με την συνδυασμένη χρήση 3-D και 3-DPD υπερηχογραφίας. Η τρισδιάστατη υπερηχογραφική μέθοδος είναι μία νέα διαγνωστική τεχνική που εξασφαλίζει ακριβή και λεπτομερειακή ανάλυση της υπό εξέταση περιοχής με μία μόνο σάρωση 360ο. Η ανακατασκευή και ανασύνθεση πολλαπλών εικόνων έχει σαν τελικό αποτέλεσμα την παρουσία 3 πλάνων, τα οποία μπορούν να μετατοπιστούν ή να περιστραφούν γύρω από τους άξονες x,ψ,z. Πληρέστερη και πιο λεπτομερειακή αξιολόγηση του ωοθηκικού όγκου γίνεται εφικτή με την χρήση ειδικών μεθόδων (modes). To 3-DPD απεικονίζει το αγγειακό δίκτυο του ωοθηκικού νεοπλάσματος στις 3 διαστάσεις, επιτρέποντας την άμεση απεικόνιση των πολλαπλώς αναδιπλούμενων αγγείων, με αποτέλεσμα την ποσοτική και ποιοτική ανάλυση της αγγειακής αρχιτεκτονικής. Αναλύθηκαν 8 μορφολογικά κριτήρια (τοιχωματικές ανωμαλίες, ακουστική σκίαση, διαφραγμάτια <3mm, συμπαγή στοιχεία, ηχογένεια, η ύπαρξη ελεύθερου περιτοναϊκού υγρού, η σχέση του ωοθηκικού όγκου με παρακείμενους ιστούς και όργανα, και 3 κριτήρια με την εφαρμογή του 3-DPD [αγγειακή διάταξη, διακλάδωση και ο δείκτης αγγειακής αντίστασης (R.I)], με βάση τη βαθμολογική κλίμακα (scoring system) κατά Kurjak. Παράλληλα, όπου κρίθηκε απαραίτητο, ορισμένες ασθενείς υποβλήθηκαν σε περαιτέρω απεικονιστικό έλεγχο (αξονική ή μαγνητική τομογραφία), έλεγχο των καρκινικών δεικτών και τέλος αναλύθηκαν δημογραφικοί παράγοντες και σημειώθηκαν το βεβαρημένο κληρονομικό και ατομικό αναμνηστικό. Όλες οι γυναίκες χειρουργήθηκαν και τα αποτελέσματα της ιστολογικής συγκρίθηκαν με τα ευρήματα της τρισδιάστατης υπερηχογραφίας. Τα κακοήθη ωοθηκικά νεοπλάσματα σταδιοποιήθηκαν σύμφωνα με την διεθνή ομοσπονδία Μαιευτήρων-Γυναικολόγων (F.I.G.O.) Στατιστική ανάλυση: Η διακριτική ικανότητα του 3-D υπερήχου αξιολογήθηκε με την χρήση της καμπύλης R.O.C. Η συσχέτιση της βαθμολόγησης των 3-D υπερηχογραφικών κριτηρίων με τα χαρακτηριστικά του δείγματος, έγινε με την χρήση της x² κατανομής. Αποτελέσματα: Στην παρούσα μελέτη έλαβε μέρος ο μεγαλύτερος αριθμός ασθενών (318 γυναίκες) σε σύγκριση με τα βιβλιογραφικά δεδομένα και εξετάσθηκαν γυναίκες αναπαραγωγικής ηλικίας, ανεξαρτήτως της φάσης του κύκλου τους, πιστοποιώντας έτσι την αντικειμενικότητα των αποτελεσμάτων

PRIMARY BENIGN ERYTHROCYTOSIS WITH HIGH ERYTHROPOIETIN LEVELS AND AN EARLY ERYTHROPOIETIN-SENSITIVE POPULATION IN THE PERIPHERAL-BLOOD

Primary erythrocytosis diagnosed in a 10-month-old female and followed for 12 years is described. The erythrocytosis was associated with an abnormally elevated set point of erythropoietin production in which the sensitivity fluctuated independently, but corresponded to the alterations in the oxygen-carrying capacity of the blood, when the hematocrit was lowered by phlebotomies. Extensive work for secondary erythrocytoses failed to demonstrate a recognizable cause for this abnormal erythropoietin production. Erythroid cell cultures from peripheral blood mononuclear cells showed the existence of at least two populations: one consistent with dramatic expansion of the erythron in keeping with enhanced sensitivity to endogenous erythropoietin, and the other consistent with the features of typical colonies derived from burst-forming units-erythroid (BFU-Es), seen in normal peripheral blood on days 12 to 14 of culture. The expanded population was characterized by the appearance of single colonies on days 4 to 6 and enormous response to the increasing amounts of erythropoietin, which enhanced their number, size, and maturation. The combination of clinical and in vitro data as well as the absence of any abnormality in the erythropoiesis of the parents and sibling suggest that the erythrocytosis in this child represents a new form with a benign course