Ultrasonographic markers of endometrial receptivity of letrozole and clomiphene citrate in unexplained infertile women

Objective: To compare endometrial receptivity of letrozole and clomiphene citrate. Study design: A prospective comparative study. Subjects: 120 women with unexplained infertility undergoing superovulation. Intervention: Sixty patients underwent ovulation induction using 5 mg letrozole compared with another 60 patients using 100 mg clomiphene citrate. Main outcome: The endometrial thickness, the endometrial volume, uterine artery and spiral artery Doppler indices at 7 days after HCG administration. Results: The mean age, parity and duration of infertility in both groups of patients were similar. There was a significant difference in the endometrial thickness, endometrial volume, and spiral artery Doppler indices between the two groups one week after HCG administration. No difference was found in the uterine artery Doppler indices in both groups. The pregnancy rate was higher in the letrozole group but it was statistically insignificant. Conclusion: Letrozole (5 mg) showed a significantly better endometrial response than 100 mg of clomid

Tuberculous cervicitis mimicking cancer cervix: A case study

Background: Primary Tuberculosis of the uterine cervix is an unusual event, with only a few cases reported in the English literature. Case report: A 25 year old nulligravid woman was referred to our hospital with suspected cervical carcinoma. General, gynecologic, colposcopic and microbiologic assessments were done. Diagnosis of cervical tuberculosis was confirmed on histologic examination. The patient received anti-tuberculous therapy and has been disease free for 12 months. Conclusion: Cervical tuberculosis may mimic cervical carcinoma and should be included in the differential diagnosis especially in endemic countries

The accuracy of transvaginal ultrasound and uterine artery Doppler in the prediction of adenomyosis

Objective: To measure the accuracy of the ultrasonographic features in predicting adenomyosis and to determine if there is a role for uterine artery Doppler in adenomyosis prediction. Study design: A prospective comparative study. Setting: Cairo University hospital. Materials and methods: Three hundred and fifty-two women who were scheduled for hysterectomy for various indications underwent preoperative transvaginal ultrasound scan (TVS) and uterine artery Doppler velocimetry in an attempt to diagnose adenomyosis. All the results were then correlated with histopathological results after hysterectomy. Results: Forty-eight participants were ultrasonographically diagnosed as having adenomyosis from which 37 patients were histologically confirmed. Both groups were comparable in age, but adenomyosis tend to occur in multiparas. We found that subendometrial linear striations, myometrial cysts’ number and poor endometrial delineation were significantly associated with adenomyosis. Sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of TVS for diagnosing adenomyosis were: 75.68%, 90.79%, 49.12%, 96.95% and 89.20%, respectively. Heterogenous myometrial echotexture was the most common ultrasonographic feature in adenomyotic cases. Neither uterine artery resistance index nor pulsatility index showed significant association with adenomyosis. Conclusion: TVS is a potentially valuable tool in predicting adenomyosis especially when subendometrial linear echogenic striations, myometrial cysts, and poor endometrial delineations were found. However, uterine artery Doppler has no diagnostic values

Can Three-dimensional (3D) power Doppler and uterine artery Doppler differentiate between fibroids and adenomyomas?

Purpose: To determine if the three-dimensional power Doppler and uterine arteries Doppler were able to differentiate between fibroids and adenomyomas. Methods: 123 patients who were scheduled for hysterectomy were enrolled in the study. They were evaluated by ultrasound before hysterectomy. We included only cases with either fibroids or adenomymas. For each benign myometrial mass, mass volume, 3D power Doppler vascularization index (VI), flow index (FI) and vascularization flow index (VFI) and uterine artery Doppler indices were measured. The results were compared with the histopathological examination. Results: No significant difference was detected between the volume of the fibroids or the adenomyomas (P = 0.896). There was significant difference in the vascular location of the power Doppler flow between fibroids and adenomyomas being more scattered in adenomyoma and more peripheral in fibroids (P < 0.00). In fibroids, higher 3D power Doppler vascular flow (VI = 2.42 ± 2.0, FI = 39.931 ± 5.8 and VFI = 1.29 ± 1.54) than adenomyomas (VI = 1.19 ± 1.04, FI = 28.33 ± 6.88, VFI = 0.89 ± 0.49). That was statistically significant (P = 0.005, 0.00, 0.004) respectively. The uterine artery Doppler indices (RI, PI) showed no significant difference between fibroids and adenomyoma (P = 0.349, 0.067). Conclusion: 3D power Doppler can differentiate between fibroids and adenomyomas. The uterine arteries Doppler Can’t differentiate between fibroids and adenomyomas