Editor's piece

My time as interim editor is over. I hand over the reins to Dr George Larcos. As of this issue, the ASUM Ultrasound Bulletin will be no longer. It will be replaced with Australasian Journal of Ultrasound in Medicine. In keeping with an increase in the number of quality peer reviewed articles, this is a positive step. WFUMB 2009 has about 700 online submitted abstracts. This huge number of abstracts is a testament to Rob Gibson and the WFUMB organising committee, who have delivered an exciting, cutting edge program for this year’s Sydney meeting in late August. Register online now for the early bird reduced fee. In organising the gynaecological ultrasound program, we have managed to attract the best international speakers from Europe, USA and Asia. These include Davor Jurkovic, Tommaso Bignardi, Steve Goldstein, Nick Raine-Fenning, Antonia Testa, Jing Zhang, Pavlos Sladkevicius, Dalya Alhamdan and Hans Peters Dietz. This is just to name a few! Keep the 30th August– 3rd September 2009 free. The WFUMB program and session layout are featured in this issue. In this issue, Davor Jurkovic, an invited speaker at this year’s WFUMB meeting, and expert in early pregnancy complications, discusses the ever-increasing caesarean section scar ectopic pregnancies (CSEPs). Davor has the greatest worldwide experience in CSEPs and his piece gives a balanced overview. This rare but potentially dangerous form of ectopic pregnancy seems to be gathering notoriety as more and more women are being diagnosed with this condition. In his opinion piece, Davor highlights the lack of consensus when it comes to this diffi cult clinical situation. In modern practice, the available evidence suggests that these women should be managed surgically with an ultrasound-guided curettage. He also advocates individualising the management of these women, as the decision to terminate a viable CSEP may be a diffi cult call for the couple involved. This topic will feature heavily at the WFUMB meeting later this year, so ensure you have read up on the topic prior to coming to Davor’s lectures. At Nepean Hospital, we have now seen and managed 10 in the last two years using intra-operative transrectal ultrasound guided curettage. I think it is important for this condition to be managed by tertiary early pregnancy units with experience in CSEP; feel free to refer your CSEPs to us. The images featured on the front cover are a CSEP at fi ve weeks’ gestation; preand post-methotrexate management. As you can appreciate from the images, that after successful medical treatment, an enlarged gestational sac persisted in the myometrial scar defect despite a negative serum hCG. This case highlights the downside to conservative management and the need for surgical intervention in this rare from of ectopic pregnancy. Elisabeth Epstein, from Lund in Sweden, an expert in the management of women with postmenopausal bleeding (PMB), delivers an evidence based approach to women with PMB. Her feature piece, The use new and old ultrasound techniques in the assessment of women with postmenopausal bleeding gives an overview on the current state of play for the role of ultrasound and in particular transvaginal ultrasound in the management of these women. Elisabeth has published extensively on the postmenopausal endometrium. In her review she concludes that “women with an endometrial thickness (ET) <5 mm can be managed expectantly but do not forget to rule out cervical cancer. Saline infusion sonohysterography (SIS) should be performed in all women with PMB with an ET ≥5 mm to rule out focal lesions. All women with focal lesions should undergo operative hysteroscopy, since these lesions will not be adequately removed or diagnosed with blind sampling procedures. One should suspect endometrial cancer in lesions with multiple vessels, irregular echogenicity, or an irregular surface at SIS”. This step by step approach to a common clinical problem is worth the read. This issue also features well presented peer-reviewed articles including Long saphenous vein and its anatomical variations; Ultrasound of the eye; and The value of screening for major fetal abnormalities during the nuchal translucency examination. Finally, don’t forget to visit the offi cial WFUMB website http://www.wfumb2009.com to see the program and list of international and local speakers. ASUM’s hosting of this Olympics of ultrasound meetings will not disappoint! See you there.