Cap-Assisted Technique versus Conventional Methods for Esophageal Food Bolus Extraction: A Comparative Study

Background/Aims Food bolus impaction is the most common form of esophageal foreign body impaction observed in adults. Clinical guidelines recommend using the push technique or retrieval methods in such cases. The push technique can cause injuries in certain clinical situations. Notably, conventional retrieval methods are time and effort consuming. Cap-assisted endoscopic extraction of an impacted food bolus is an easy and effective technique; however, more data are needed for its validation. This study compared the capassisted extraction technique with conventional methods. Methods This prospective observational multicenter study compared the success and en bloc removal rates, total procedure time, and adverse events in both techniques.. Results The study included 303 patients who underwent food bolus extraction. The push technique was used in 87 patients (28.7%) and a retrieval procedure in 216 patients (71.3%). Cap-assisted extraction was performed in 106 patients and retrieval using conventional methods in 110 patients. The cap-assisted technique was associated with a higher rate of en bloc removal (80.2% vs. 15%, p<0.01), shorter procedure time (6.9±3.5 min vs. 15.7±4.1 min, p<0.001), and fewer adverse events (0/106 vs. 9/110, p<0.001). Conclusions Cap-assisted extraction showed no adverse events, higher efficacy, and a shorter procedure time compared with conventional retrieval procedures

Anti-Müllerian hormone in polycystic ovary syndrome and normo-ovulatory women: Correlation with clinical, hormonal and ultrasonographic parameters

Background: Although the ultimate pathogenesis of polycystic ovary syndrome (PCOS) remains obscure, the distinctive feature is failure of follicular maturation resulting in anovulation and accumulation of preantral and small antral follicles which contribute significantly to the production of anti-Müllerian hormone (AMH). Objectives: To compare serum AMH levels between PCOS and normo-ovulatory women; and to investigate whether AMH correlates to clinical, hormonal and ultrasonographic parameters in both groups. Design: Comparative observational cross-sectional study. Setting: Department of Obstetrics and Gynecology, Kasr El-Aini Teaching Hospital, Faculty of Medicine, Cairo University. Subjects: Thirty-five women with PCOS according to the Rotterdam consensus; and 35 normo-ovulatory-matched controls with male, tubal or unexplained infertility. Methods: Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, androstenedione, estradiol, fasting insulin and AMH were measured in the early follicular phase (day 3–4) of natural cycle or progestin-induced withdrawal bleeding (in PCOS); together with transvaginal sonography for detection of the number of small follicles (<10mm) and calculation of ovarian volume. Main outcome measures: Correlation between AMH and clinical, hormonal and ultrasonographic parameters in both groups. Results: AMH was significantly higher in the PCOS group. In the whole group of patients and in each group separately, AMH was positively correlated to LH, LH/FSH, number of follicles <10mm and ovarian volume; and negatively correlated to FSH. No correlation was found between AMH and age, BMI, estradiol or fasting insulin. Testosterone and androstenedione were positively correlated to AMH in the PCOS group exclusively (r=0.557; P=0.001 and r=0.451; P=0.007, respectively). Multiple regression analysis demonstrated that testosterone was the only determinant for AMH level (r=0.485; P<0.001). Conclusions: Hyperandrogenism is associated with increased AMH secretion in PCOS patients, possibly due to increased number of small antral follicles. Assessment of AMH levels before and after the treatment of hyperandrogenism should be recommended in the plan of management of PCOS

Effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women

Akmal El-Mazny, Ahmed Kamel, Wafaa Ramadan, Sherine Gad-Allah, Suzy Abdelaziz, Ahmed M Hussein Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt Background: Angiogenesis has been found to be among the most important factors in the pathogenesis of endometriosis. The formation of new blood vessels is critical for the survival of newly implanted endometriotic foci. The use of 3-D power Doppler allows for the demonstration of the dynamic vascular changes that occur during the process of in vitro fertilization (IVF). We aimed to evaluate the effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women. Materials and methods: In a case&ndash;control study at a university teaching hospital, 138 women with unilateral ovarian endometrioma scheduled for IVF were compared to 138 women with male-factor or unexplained infertility. In the mid-luteal (peri-implantation) phase of the cycle, endometrial thickness, uterine and ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, 3-D power Doppler vascularization index (VI), flow index (FI), and vascularization FI (VFI) values were measured in both groups. Results: There were no significant differences (P&gt;0.05) in endometrial thickness, uterine ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, or VI, FI, and VFI between the two groups. Furthermore, the endometrial and ovarian Doppler indices were not influenced by endometrioma size. No significant differences were observed in the ovarian Doppler indices between endometrioma-containing ovaries and contralateral ovaries. Conclusion: Ovarian endometrioma is not associated with impaired endometrial and ovarian blood flows in infertile women scheduled for IVF, and it is not likely to affect endometrial receptivity or ovarian function through a vascular mechanism. Keywords: 3-D power Doppler, endometrioma, IVF, uterine and ovarian blood flo

Comparison Between Placental 3D Power Doppler and Uterine Artery Pulsatility Index in Early Prediction of Pre-eclampsia

Aim of the work: To compare between placental 3D Power Doppler vascular indices and uterine artery pulsatility index in early prediction of preeclampsia. Methods: The prospective comparative observational cohort study included 200 women in their first trimester at 11–14 weeks of pregnancy divided into 2 groups. 100 women with no risk factor to develop preeclampsia (control group), 100 women with any risk factor to develop preeclampsia (case group). All women were examined by 3D abdominal ultrasound, Blood flow in placenta was examined using 3D power Doppler technique for the placental vascular indices. Uterine artery pulsatility index was also assessed. All Patients were followed up to the end of their pregnancies and their medical files reviewed to obtain whether patients developed preeclampsia and other hypertensive disorders. Results: Overall, 17 women developed pre-eclampsia while 183 women remained normotensive (7 out of 100 women in the control group and 10 out of 100 women in the case group). In both groups the women with pre-eclampsia had significantly lower placental vascular indices (vascularization-index, flow index, and vascularization flow index) compared with the normotensive women. In contrast, women with pre-eclampsia in both groups had significantly high mean uterine pulsatility index compared with the normotensive women

Effect of clomiphene citrate on uterine hemodynamics in women with unexplained infertility

Eman Omran, Mohamed El-Sharkawy, Akmal El-Mazny, Mohamed Hammam, Wafaa Ramadan, Dina Latif, Dalia Samir, Sherine Sobh Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt Purpose: The aim of the study was to evaluate the effect of clomiphene citrate on uterine artery blood flow using pulsed Doppler and endometrial and subendometrial micro vascularization using 3D power Doppler in unexplained infertility. Patients and methods: In a prospective observational study at a university teaching hospital, the mid-luteal (peri-implantation) endometrial thickness and volume, uterine artery pulsatility index (PI) and resistance index (RI), endometrial and subendometrial vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and serum estradiol and progesterone levels were compared between natural and clomiphene citrate stimulated cycles in the same group of 50 patients with unexplained infertility. Statistical analysis was done using paired t-test to compare different study variables. Results: The primary outcome, which was the endometrial flow index, was significantly lower in the stimulated cycles (mean &plusmn; SD: 23.89&plusmn;7.96 vs 27.49&plusmn;8.73, mean difference (95% CI): -3.6 (-2, -5.9);&nbsp;P=0.03). The mean &plusmn; SD of endometrial thickness (10.92&plusmn;3.04 vs 12.46&plusmn;3.08&nbsp;mm;&nbsp;P=0.01), volume (4.57&plusmn;1.28 vs 5.26&plusmn;1.32 cm3;&nbsp;P=0.009), endometrial VI (0.86&plusmn;0.15 vs 0.95%&plusmn;0.21%;&nbsp;P=0.02), VFI (0.25&plusmn;0.08 vs 0.31&plusmn;0.12; P=0.004), subendometrial VI (1.93&plusmn;0.68 vs 2.26%&plusmn;0.75%;&nbsp;P=0.02), FI (26.81&plusmn;9.16 vs 30.73&plusmn;9.87;&nbsp;P=0.04), and VFI (0.68&plusmn;0.18 vs 0.79&plusmn;0.21;&nbsp;P=0.006) were significantly lower in the stimulated cycles. However, there were no significant differences in the uterine artery PI (P=0.12) and RI (P=0.08) or serum estradiol (P=0.54) and progesterone (P=0.37) levels between natural and stimulated cycles. Conclusion: Peri-implantation endometrial perfusion is significantly lower in clomiphene citrate stimulated cycles when compared to natural ones in patients with unexplained infertility. Keywords: subendometrial blood flow, 3D power Doppler, endometrial blood flow, uterine artery Dopple

Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis

Abstract Objective To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS). Data sources Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis. Study eligibility criteria All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them. Study appraisal and synthesis methods Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity. Results The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively. Conclusions The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases. Trial registration Number CRD42021267501