We evaluated 14,317 asymptomatic or minimally symptomatic women for ovarian carcinoma with transvaginal color Doppler ultrasound. The resistance index was calculated for at least five separate cardiac cycles in each case, and the mean was calculated. We discovered 624 benign adnexal masses: in every case except one the resistance index was >0.40. There were 56 malignant adnexal masses, 16 of which were stage I ovarian cancers. Neovascularization was found in six 0 varian carcinoma is the major lethal gynecological neoplasm in Western countries.1 Yugoslavia is no exception. The poor prognosis of this neoplasm is generally due to its late presentation. Symptoms do not appear in most cases until the primary lesion has spread. Diagnosis of ovarian carcinoma at an early stage was very unusual before we introduced color Doppler ultrasound in 1987 for examination of the pelvic organs.1 Color Doppler detects blood flow in small low-resistance vessels 1 · 3 that form in neoplastic tissue. 4 Pulsed Doppler is then used to quantify such color-coded flow using Pourcelot's resistance index." Ovarian malignancy is thus differentiated from other lesions that produce similar but not identical patterns of flow. • 3 • 6We present 14,317 asymptomatic or minimally symptomatic women evaluated for ovarian carcinoma with color Doppler ultrasound and followed up with this technique.Received from the Ultrasonic Institute, University of Zagreb, Zagreb, Yugoslavia.Address correspondence and reprint requests to Dr. PATIENTS AND METHODSClinics referred 8620 asymptomatic women for color Doppler examination. Gynecologists referred 5697 women because of suspected adnexal mass. Of these women 7495 (87%) were premenopausal (age 18-51; mean 42) and 1125 were postmenopausal (age range 49-72; mean 56). Each woman was examined by one of three doctors experienced in the technique of color Doppler ultrasound. Every examination included abdominal B-mode and vaginal color Doppler scanning with pulsed-Doppler examination.The equipment used was an SSD-680 with a 5-MHz transvaginal probe (Aloka, Japan). The uterus and in· dividual adnexal organs were examined. The resistance index (Rl) 5 was calculated from at least five separate cardiac cycles, and the mean of these was calculated. Observer differences between the three examining doctors were not statistically significant; in 10 cases examined by three observers the maximum difference in the RI obtained in any one case was 0.09 (12%).In premenopausal women the examinations were carried out between days 3 and 10 of the menstrual cycle to avoid false positive results as a consequence of increased ovarian flow during the luteal phase.

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In Brief For pregnant women with diabetes, using cell phone/Internet technology to track and report self-monitoring of blood glucose results improves compliance and satisfaction compared to using the more traditional methods of log books, telephone calls, and voicemail messages.

Placenta accreta is now the chief cause of postpartum hemorrhage resulting in maternal and neonatal morbidity. Prenatal diagnosis decreases blood loss at delivery and intra and post-partum complications. Ultrasound is critical for diagnosis and MRI is a complementary tool when the diagnosis is uncertain. Peripartum hysterectomy has been the standard of therapy but conservative management is increasingly being used. The etiology of accreta is due to a deficiency of maternal decidua resulting in placental invasion into the uterine myometrium. The molecular basis for the development of invasive placentation is yet to be elucidated but may involve abnormal paracrine/autocrine signaling between the deficient maternal decidua and the trophoblastic tissue. The interaction of hormones such as Relaxin which is abundant in maternal decidua and INSL4, an insulin like peptide found in placental trophoblastic tissue may play role in the formation of placenta accreta.