Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels

Endovaginal sonography results were compared with quantitatively determined human chorionic gonadotropin (hCG) levels in 84 women referred for early pregnancy complications. Of the 27 with normal intrauterine pregnancies, an intrauterine gestational sac was prospectively identified in one of five cases (20%) in which hCG levels were below 500 IU/L (Second International Standard), four of five (80%) with hCG levels of 500-1,000 IU/L, and all 17 with hCG levels above 1,000 IU/L. In comparison, 17 of the 26 women with ectopic pregnancies (65%) had hCG levels greater than 1,000 IU/L, and none of the 26 had an intrauterine gestational sac. Endovaginal sonography demonstrated an adnexal mass and/or a gestational sac-like structure in 16 of the 17 cases (94%) in which hCG levels were above 1,000 IU/L, compared with only three of the nine (33%) with lower hCG levels (P less than .01). These findings indicate that an intrauterine gestational sac should be normally visualized with endovaginal sonography when the hCG level exceeds 1,000 IU/L, and that visualization of an extrauterine gestational sac and/or adnexal mass is significantly more likely in ectopic pregnancies when the hCG level exceeds 1,000 IU/L.     

Optimum perception of odor intensity by humans

The sniff duration that provides optimum perception of odor intensity was determined for 17 humans. Subjects were trained to match the duration of their sniff to the duration of a buzzer that sounded for 0.2, 0.5, 1.0 or 2.0 sec. Sniff characteristics were monitored with a hot wire anemometer and an oscilloscope. Intensity estimates were obtained at the four durations for three concentrations of phenyl ethanol, butanol and propionic acid. Optimum perception of intensity occurred between 0.39 and 0.64 sec for phenyl ethanol and propionic acid and a value of no more than 1.63 sec is proposed for butanol. The longer duration for butanol is attributed to the delayed response of nerves in the throat which appear to respond to this odorant but not to the others. The complexity of the intensity sensation and implications of the results for neurophysiological studies of intensity coding are discussed and the properties of an olfactometer for odor intensity measurements are outlined.     

Rotator cuff tear: clinical experience with sonographic detection

Between June 1986 and April 1988, 86 sonographic examinations of the shoulder were performed on patients suspected of having rotator cuff tears. Major sonographic diagnostic criteria included (a) a well-defined discontinuity usually visible as a hypoechoic focus within the cuff, (b) nonvisualization of the cuff and (c) an echogenic focus within the cuff. Seventy-five patients underwent both sonography and arthrography. Compared with arthrography alone, ultrasound examinations enabled detection of 92% of rotator cuff tears (24 of 26 tears), with a specificity of 84% and a negative predictive value of 95%. Correlation was obtained in 30 of these patients who underwent surgery for rotator cuff tear or other soft-tissue abnormality. In this group, the sensitivity of sonography for detection of a tear was 93%, with a specificity of 73%, while for arthrography sensitivity was 87% and specificity was 100%. These data indicate that sonography is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury.     

Ultrasonographic identification of dilated intrahepatic bile ducts and their differentiation from portal venous structures.

The appearance of dilated intrahepatic bile ducts was evaluated on ultrasonograms of 50 patients with proven extrahepatic biliary obstruction. Five characteristic changes allowed differentiation between biliary and portal venous systems. These changes included: 1) alteration in the anatomic pattern adjacent to the main right portal venous segment and the main portal vein bifurcation. 2) Irregular walls of dilated bile ducts. 3) Stellate confluence of dilated bile ducts. 4) Acoustic enhancement by dilated bile ducts. 5) Peripheral location of dilated bile ducts. Many patients exhibited more than one of these findings. Parasagittal scans of the main right portal vein were the most sensitive for detection of intrahepatic ductal dilatation. Recognition of the characteristic changes and knowledge of the portal venous anatomy makes it possible to diagnose extrahepatic biliary obstruction with a high degree of confidence.