Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging

AbstractObjectiveTo estimate the accuracy of 3-dimensional transvaginal ultrasonography (3D-TVUS), hysterosalpingography (HSG) and pelvic magnetic resonance imaging (MRI) in the differentiation between septate and bicornuate uterus.Patients and methodsThirty-six patients with suspected septate or bicornuate uterus on 2D ultrasound or hysterosalpingography (HSG) underwent 3D-TVUS examination, MR imaging, diagnostic laparoscopy and hysteroscopy. HSG was performed only for those patients who did not undergo the procedure before (21 patients), we retrospectively revised the hysterosalpingography of 15 patients performed outside our hospital with acceptable quality.ResultsHSG showed sensitivity of 77.4%, specificity of 60% and overall accuracy of 75% in the differentiation between the septate and bicornuate uterus. MRI showed sensitivity of 93.5%, specificity of 80%, PPV of 96.6% and negative predicative value of 66.6%, with overall accuracy of 91.6%. The 3D ultrasound showed the highest diagnostic parameters, with sensitivity of 96.7%, specificity of 100%, PPV of 100% and negative predicative value of 83.3%, with overall accuracy of 97.2%.ConclusionsTransvaginal 3-D ultrasonography is accurate for diagnosis and differentiation between septate uterus and bicornuate uterus. We recommend 3-D transvaginal ultrasonography as the first and only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus, especially before planning surgery. MRI should be preserved for patients in whom 3D TVS is not possible like virgins

Effect of bilateral uterine artery ligation in cases of postpartum hemorrhage on ovarian reserve

Background: Bilateral uterine artery ligation (BUAL) is a fertility-preserving procedure used in women experiencing postpartum hemorrhage (PPH). However, the long-term effects of this procedure on ovarian reserve remain unclear. Aim to investigate the effect of BUAL in cases of PPH on ovarian reserve, Methods: This study was carried out at department of obstetrics and gynecology Tanta university on 40 patients divided into 2 groups: (The study group); included 20 patients underwent cesarean section with successful BUAL for intractable atonic PPH, (The control group); included 20 patients underwent cesarean section without BUAL; during a period between April 2020 and December 2021, Results: There is no-significant difference between study and control group according to AMH (ng/ml), resistivity index (RI) and pulsatility index (PI) of right and left uterine artery and ovarian artery after 6 months of bilateral UAL, Conclusions: Bilateral UAL had no negative effects on ovarian reserve or ovarian blood supply, so this treatment should be used as a fertility preservation technique to avoid hysterectomy in patients experiencing PPH

Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography

Purpose: To evaluate the accuracy of computed tomography pulmonary angiography (CTPA) parameters, for predicting short-term mortality in patients with acute pulmonary embolism (PE). Materials and methods: Thirty-two patients with proven PE had CT pulmonary angiography were included in the study. The clot burden using the Qanadli score (QS), and the right ventricular dysfunction (RVD) parameters were assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios, interventricular septum abnormality, inferior vena cava contrast reflux, azygous vein and superior vena cava measures. Contrast density in pulmonary artery and descending aorta was evaluated for all patients. Patients were followed up for 30 days and then classified as survivors or non survivors. Results: Thirty-two patients were included in the study, 23 (71.8%) of them were classified as survivors, and the other nine (28.1%) patients died within the first month (non survivors). There was a positive, but weak correlation between the Qanadli score and the short term mortality (P value = 0.05). There was a statistically significant relationship between the RV/LV ratio and PE-related mortality, with a P value < 0.001. Also, there was a good correlation between degree of IVC reflux and PE outcome (P < 0.001). The PA/AO diameter ratio, SVC diameter and azygous vein diameter showed no statistically significant difference between survivors and non survivors. Conclusions: CTPA findings that may predict short term mortality are the high grades of inferior vena cava reflux, RV/LV diameter ratio more than 1.2, and clot burden >18 according to the Qanadli score and to a lesser degree the interventricular septum abnormality

Can ultrasound elastography distinguish metastatic from reactive lymph nodes in patients with primary head and neck cancers?

Objectives: The purpose of this study was to evaluate the diagnostic utility of real-time elastography (RTE) in differentiating between reactive and metastatic cervical lymph nodes (LN) in patients with primary head and neck cancer in comparison with the conventional B mode and power Doppler parameters. Methods: A total of 127 lymph nodes in 78 patients with primary head and neck cancer were examined by B-mode sonography, power Doppler ultrasound and elastography. Elastographic patterns were determined on the distribution and percentage of the lymph node area with low elasticity (hard), with pattern 1 being an absent or very small hard area to pattern 5, a hard area occupying the entire lymph node. Patterns 3–5 were considered metastatic. Ultrasound guided aspiration cytology was done for 57 lymph nodes. Excision biopsy was done for 52 lymph nodes. Eighteen lymph nodes responded to conservative treatment, and were considered reactive. Results: The majority (85.3%) of the metastatic lymph nodes had elastography pattern 3–5. This finding was observed in only 5% of the benign lymph nodes (P < 0.001). The elastography pattern had sensitivity of 85.3%, specificity of 95.5%, PPV of 97.2%, NPV of 78.1% and overall accuracy of 88.9% in differentiation between benign and malignant lymph nodes. On the other hand, for the B mode criteria, the best accuracy was given to abnormal hilum (83%). The accuracy of power Doppler ultrasound pattern was 70.8%. Conclusions: The accuracy of sonoelastography is higher than usual B mode and power Doppler ultrasound parameters in differentiation between benign and malignant nodes. The integration of lymph node sonoelastography in the follow up of patients with known head and neck cancer may reduce the number of biopsies

Potential predictors for successful misoprostol treatment for early pregnancy failure: Clinical and color Doppler imaging study

Objective: To identify the clinical characteristics and features of color Doppler imaging related to successful misoprostol treatment for early pregnancy failure. Design: Prospective observational study. Main outcome measures: Factors related to successful misoprostol treatment for early pregnancy failure. Materials and methods: Four groups of women with early pregnancy failure (missed, anembryonic and incomplete miscarriage) were included in the study. The first group included 159 cases, 73 were presenting with active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration and 86 cases were not presenting with these symptoms. The parity of all participants was ⩾2. The second group included 143 cases that did not present with vaginal bleeding and/or abdominal colic. The parity was 0–1 in 66 cases and ⩾2 in 77 cases. The third group included 34 cases of missed miscarriage and 22 cases of anembryonic pregnancy presenting with active vaginal bleeding and/or localized abdominal colic and the parity was 0–1.The fourth group included 172 women, blood flow was detected by color Doppler imaging in the trophoblastic tissue in 90 cases and was absent in 82 cases. All participants in this group did not present with vaginal bleeding and/or localized abdominal colic and their parity was ⩾2. All participants in the four groups were given 800 μg vaginal misoprostol on day 1 of treatment. If the miscarriage was not complete on day 3 the same dose was repeated. On day 8 they were submitted to dilatation and evacuation if miscarriage was not complete. Miscarriage was considered complete when no gestation sac was detected in the uterine cavity on transvaginal ultrasonography. Results: First group: the success rate of the two doses of misoprostol, when active vaginal bleeding and/or localized abdominal colic were present, was 94.52% (69 out of 73 cases). In absence of these symptoms the success rate was 75.58% (65 out of 86 cases). The difference was statistically (p = 0.0241) significant. Second group: the success rate of the two doses of misoprostol, when parity was 0–1, was 98.48% (65 cases out of 66). When parity was ⩾2 the success rate was 85.71% (60 cases out of 77). The difference was statistically (p = 0.0442) significant. Third group: the success rate of the first dose of misoprostol for missed miscarriage was 97.05%, 33 cases out of 34 cases and 100% for anembryonic miscarriage, 22 out of 22 cases. One case of missed miscarriage needed a second dose of misoprostol to complete the miscarriage. Fourth group: the success rate of the two doses of misoprostol, when blood flow was detected in the IVS of missed miscarriage and anembryonic pregnancy, was 100.0% (62 out of 62 cases). When blood flow was not detected in the IVS the success rate was 83.92% (47 out of 56 cases). The difference was statistically (p = 0.0422) significant. When blood flow (vascularity) was detected in the trophoblastic tissue of incomplete miscarriage the success rate was 75.0% (21 out of 28 cases) but when no blood flow (vascularity) was detected the success rate was 100% (26 out of 26 cases). The difference was statistically (p = 0.0331) significant. Conclusions: The potential predictors for successful misoprostol treatment for early pregnancy failure may be one or more of the following: 1. Active vaginal bleeding and/or localized abdominal colic in the 24 h preceding misoprostol administration. 2. Nulliparity or low parity not more than 1. 3. Blood flow in the presumed IVS of missed miscarriage or anembryonic pregnancy and absence of blood flow (vascularity) in trophoblastic tissue of incomplete miscarriage. Women, with early pregnancy failure, presenting with a combination of active vaginal bleeding and/or abdominal colic and parity 0–1, the success rate of the first-dose of vaginal misoprostol (800 μg) may reach >97% in missed miscarriage and 100% with anembryonic pregnancy

Transbronchial bullous volume reduction in COPD patients

Introduction: COPD patients with advanced disease achieve minimal or no control despite proper medical therapy that necessitates more radical approach. The bullae accentuate the altered elastic properties of the emphysematous lung and contribute to the expiratory flow limitation. Objective: The aim was to evaluate the therapeutic utility and safety of transbronchial volume reduction of emphysematous bullae in COPD patients. Patients & methods: At the site of entry, the air from the bulla was aspirated slowly, and then 10 cm of autologous blood was instilled into the bulla before the needle was withdrawn. Clinical, functional & radiological assessment of bulla volume and the incidence of adverse events were evaluated. Results: 12 male patients were enrolled in this study with mean age (±SD) 47 ± 5.6 years. The procedure was well tolerated and not associated with any serious complications. Improvements (clinically, functionally and radiologically) three months after the procedure were more obvious in patients with bullous volume 515 ml. Conclusions: Intra-bullous blood instillation could be an effective and safe volume reduction technique of emphysematous bullae

Diagnostic value of contrast-enhanced mammography in the characterization of breast asymmetry

Abstract Background Breast asymmetry is a prevalent mammographic finding described in BI-RADS atlas as asymmetry, focal asymmetry, global asymmetry, and developing asymmetry. Mammography has a limited role in discrimination between benign and malignant asymmetry, and digital mammography can overlook up to 15–30% of breast tumors. The purpose of our study was to assess the role of contrast-enhanced mammography (CEM) in distinction between benign and malignant asymmetries. Results Out of the studied 540 indeterminate and suspicious asymmetries, and according to final histopathological results, 97/540 (17.9%) asymmetries were benign, 395/540(73%) asymmetries were malignant, 48/540 (8.9%) asymmetries were normal with no underlying pathology. After comparing results of sonomammography and CEM, CEM showed higher sensitivity (96.5% vs. 85.8), specificity (77.1% vs. 64.4%), NPV (88.8% vs. 62.7%), PPV (92.04% vs. 86.7%) and accuracy (91.3% vs. 80%). Conclusions CEM has proven to be a valuable and beneficial imaging technicality for patients and radiologists, with breast cancer detection sensitivities superior to that of full-field digital mammography (FFDM) with ultrasonography (US)

Preoperative sonographic and Doppler parameters predictors of semen analysis improvement after unilateral varicocelectomy

Objective: To assess the sonographic and Doppler parameters predicting varicocelectomy outcome. Methods: This study included 86 infertile patients with abnormal semen analysis. All patients had preoperative ultrasound and color Doppler to calculate testicular volume, pampiniform vein caliber and duration of reflux in the dilated veins during sustained valsalva maneuver. The patients underwent unilateral varicocelectomy and had semen analysis 6 months after operation, improvement index of the semen analysis was calculated. Results: The patients were classified into 2 groups: Group 1: 58 patients with normal-sized testes, and group 2 included 28 patients with subnormal testes (8–12 cm3), in the first group, the patients with improvement index >0.5 were 26 (44.8%), the group with subnormal testicular volume showed improvement in 5 patients (17.8%), the difference between the two groups was statistically significant <0.05. There was a significant positive correlation between the degree of reflux preoperatively and the improvement index (P < 0.001), also there was a positive correlation between the vein diameter and the improvement index (P = 0.03). Conclusions: The best preoperative sonographic parameters of success of unilateral varicocele repair are the presence of normal-sized testes, high grade reflux, and to lesser degree large vein diameter

Apparent diffusion coefficient of renal parenchyma and color Doppler ultrasound of intrarenal arteries in patients with cirrhosis related renal dysfunction

Objectives: The aim of this work was to study the renal hemodynamic changes which occur with liver cirrhosis using diffusion weighted magnetic resonance imaging (DW-MRI) and renal color duplex Doppler ultrasound. Patients and methods: Patients were divided into four groups: Group A: 15 cirrhotic patients with compensated liver cirrhosis, Group B: 15 cirrhotic patients with refractory ascites, Group C: 15 cirrhotic patients with hepatorenal syndrome, Group D: 10 healthy persons as a control. The apparent diffusion coefficient (ADCs) of the kidneys was calculated using low b values (ADClow) and high b values (ADChigh). Color Doppler ultrasound was performed in interlobar and arcuate arteries to calculate resistive index (RI) and pulsatility index (PI) in all patients. Results: ADClow showed a statistically significant difference between patients with hepatorenal syndrome and other groups. Using ADChigh no significant difference between different groups was noted. RI and PI of both interlobar and arcuate arteries were significantly higher in all the patient groups than the control group (P < 0.0001). RI and PI of both interlobar and arcuate arteries were significantly higher in patients with hepatorenal syndrome. Conclusion: Liver cirrhosis, even in the presence of refractory ascites, did not affect the ADC value of renal parenchyma, however ADC value is affected in renal parenchyma of patients with hepato-renal syndrome. Duplex-Doppler ultrasound of intrarenal arteries enables the early detection of renal hemodynamic disturbances in patients with liver cirrhosis

Fibroscan versus liver biopsy in the evaluation of response among the Egyptian HCV infected patients to treatment

Background/aim: Hepatitis C virus (HCV) infection usually progress to chronic infection with subsequent cirrhosis and cancer. Therapies aim to eradicate the virus and prevent further progression. Interferon is claimed to have anti-fibrotic effect. Histopathology is the gold standard in diagnosis and grading of hepatic fibrosis, but transient elastogram (Fibroscan) can be used as alternative noninvasive modality. This prospective study aimed to evaluate the accuracy of fibroscan in diagnosis of liver fibrosis, and assess the effect of antiviral therapy on fibrosis stages in HCV patients. Patients and methods: The study was conducted from September 2012 to December 2014 as a project funded by Science and Technology Development Fund, Egypt, Grant No. 3448. It included 498 patients; 150 HCV cirrhotic patients as control, and 348 HCV naive patients grouped according to their liver biopsy into; mild (group I) and moderate (group II) fibrosis. They were examined using fibroscan (Echosens, Paris, France, device 502, M probe) before, 12, 24, and 48 weeks of therapy, with 300 patients (150 patients in each group) completed follow-up regardless of their response. The results of fibroscan were compared to each other and to liver biopsy. Results: Fibroscan can diagnose F1 at 6 kPa with 26% sensitivity, 8% specificity, AUC = 0.037; F2 at level of 7 kPa with 84.6% sensitivity, 71.3% specificity, AUC = 0.692 and F3 at 9.5 kPa with 96% sensitivity, 97% specificity, AUC = 0.997. The fibrosis results had regressed significantly after 48 weeks of starting therapy of both patients’ groups (p < 0.05). When categorized by response to therapy, responders showed significant decline in their fibroscan scores compared to non-responders of same fibrosis degree. Conclusion: Fibroscan correlated with histopathology in moderate (F2–F3), but not mild (F1) fibrosis. The degree of fibrosis regresses significantly in HCV responders on anti-viral INF based therapy. Besides its accuracy as noninvasive device in detecting degree of fibrosis, fibroscan can be very useful in assessment of degree of fibrosis during and after therapy