[5MHz realtime sonography of the breast. 2. Examination technic and diagnostic value]

The diagnostic value of mamma-sonography using realtime technique was evaluated in a prospective study based on the experience of 452 pathomorphologically confirmed sonographic results. Large cysts (greater than 1 cm) were correctly classified as 97%, while small cysts (less than or equal to 1 cm) were recognized in 84%. Eighty-six percent of the fibroadenomas were visualized; 50% of these lesions were classified as "benign" and 34% as "equivocal--probably benign". In 70% of the patients with mastopathic alterations, no abnormalities were detected sonographically, except when cystic lesions (greater than 3 mm) were present. Fifty-percent of the in-situ-carcinomas and small carcinomas (less than or equal to 1 cm) were recognized, while 97% of the larger carcinomas (greater than 1 cm) were demonstrated. The frequency of the different echographic criteria was analyzed with regard to the pathohistological results.

[5MHz realtime sonography of the breast. 1. Technical equipment studies]

The resolving characteristics (depth dependence of spatial resolution) of different scanning units are tested by a specially designed tissue-mimicking phantom. The phantom includes cyst-like structures (0.8-5 mm) in several layers. Additional measurements of the lateral resolution (-6 dB beam width) are performed on a spherical test object. The results are compared with regard to the requested imaging depth (visualization of the breast muscle) and the optimum focus zone (depth of pathologic breast lesions) in 307 echomammographic examinations. It is shown that the resolution characteristics and penetration depth of a 5 MHz linear-array-real-time-scanner (LS 3000, Picker Inc.) with special near-range-focus best meet the requirements of breast echography.

Circadian rhythm of serum progesterone levels in human pregnancy and its relation to the rhythm of cortisol

Progesterone and cortisol were measured in the peripheral blood of pregnant women using radioimmunoassay. Ten women were between 18 and 25 weeks of pregnancy and 10 were between 32 and 38 weeks of pregnancy. Blood for the hormone determinations was drawn at hourly intervals. A significant circadian progesterone rhythm was found with the nadir at 8.00 h and the peak around midnight. The progesterone rhythm showed a significant inverse relation to the cortisol rhythm (tau = 0.310). No difference was detected between the two groups for progesterone rhythm or its inverse relation to the cortisol rhythm.

[Diagnosis of intra-uterine growth retardation by intensive ultra-sound biometry]

In a prospective study on 125 maternity patients with suspected intra-uterine growth retardation, simple ultrasound biometry (measuring of the distance) and intensive ultra-sound biometry (measurement of the circumference and the surface) were compared. Of 85 newborn born within two weeks following the biometry 34 newborn had intra-uterine growth retardation with a weight percentile smaller than 5, and 32 newborn were growth retarded with a percentile of 5-10. In 19 cases no growth retardation was found. (12 newborn in this group had a weight percentile 10-25). The measurement of the biparietal diameter was capable of diagnosing at the most 50% of the growth retardations (percentile under 5). The accuracy of the diagnosis of intra-uterine growth retardation increased to 85% with the thoraco-abdominal transverse diameter. The so-called borderline cases (percentile 5-10) were diagnosed with the bi-parietal diameter in 38 percent of the cases and by the transverse thoracic diameter in 41% of the cases. Measurement of the circumference of the head resulted in no better measurements than the bi-parietal diameter. The addition of the measurement of the thoracic circumference increased the diagnosis of severe fetal growth retardation (percentile under 5) to 90% and in borderline cases to 88%. The head thorax index and the ratio of head circumference and thoracic circumference increase in our investigation the accuracy of the diagnosis of intra-uterine fetal growth retardation substantially.

Steroids in human myometrium and peripheral blood during the menstrual cycle

Blood samples were collected prior to vaginal hysterectomy from nine women in the proliferative phase of the cycle and from 15 women in the secretory phase, and from each uterus five grams of the fundus were obtained. The concentrations of progesterone (P), 20alpha-dihydroprogesterone (20alpha-DHP), estradiol-17beta (E2), and estriol (E3) were determined in serum and in the tissue with the use of specific radioimmunoassays. The concentrations of P and 20alpha-DHP in serum and myometrium were significantly higher in the secretory than in the proliferative phase. Furthermore, the concentration of P in myometrium was significantly higher than in serum in the secretory phase, indicating a specific uptake of P by the myometrium. The concentration of E2 was about 10 times higher in the myometrium than in the serum during both phases of the cycle and appeared to be independent of the serum levels. This indicates a specific but limited uptake of E2 by the myometrium. The E3 levels in the tissue showed no significant differences during the menstrual cycle, whereas in the serum the E3 concentrations were higher in the secretory than in the proliferative phase of the cycle.

New progesterone metabolites in human myometrium

Homogenates from human myometrium with an added NADPH regenerating system and ATP were incubated with 4-(14)C progesterone. Six metabolites were identified: 5alpha-pregnane-3, 20-dione, 5beta-pregnane-3, 20-dione, 3alpha-hydroxy-4-pregnen-20-one, 3beta hydroxy-4-pregnen-20-one. 20alpha-hydroxy-4-pregnen-3-one and 20beta-hydroxy-4-pregnen-3-one. The identification of these metabolites was based on their behaviour in paper and thin layer chromatography and especially in radiogaschromatography either as free compounds or after formation of derivatives. The identification of the two allylic metabolites was supplemented by specific microchemical and enzymatic reactions. The formation of 5beta-pregnane-3, 20-dione, 20beta-hydroxy-4-pregnen-3-one and of the two allylic alcohols 3alpha-hydroxy-4-pregnen-20-one and 3beta-hydroxy-4-pregnen-20-one in human myometrium homogenates was demonstrated for the first time.