Three-dimensional ultrasound assessment of endometrial receptivity: a review

Three-dimensional ultrasound (3D US) is a new imaging modality, which is being introduced into clinical practice. Although this technique will not probably replace two-dimensional ultrasound, it is being increasingly used. It has been reported that 3D US is a very high reproducible technique. The endometrium has been paid special attention when using this technique. The aim of this paper is to address some technical aspects of 3D US and to review critically its current status in evaluating endometrial function with special focus in its role in predicting pregnancy in assisted reproductive techniques. In spontaneous cycles endometrial volume grows during follicular phase remaining constant through the luteal phase. Endometrial vascularization increases during follicular phase peaking 2–3 days before ovulation, decreasing thereafter and increasing again during mid and late luteal phase. Data from studies analysing the role of 3D US for predicting IVF outcome are controversial. An explanation for these controversial findings might be different design of reported studies, specially the timing of ultrasound evaluation

La frontera enquistada: el reino de Murcia a fines de la Edad Media

Con el final de las grandes conquistas del siglo XIII, la frontera con el recién creado reino de Granada quedó prácticamente estancada. El presente artículo estudia la situación del territorio murciano y el efecto que la presencia de la cercana frontera ejerció sobre él. Se hace referencia a organización del territorio, a la concentración de la población en grandes núcleos como Lorca, Caravaca, Cehegín y otros. Se alude también a la función que la frontera murciana ejerció, como lugar de refugio político, en el contexto de las luchas internas de la región entabladas en el siglo XV. Todo ello permite a los autores trazar un amplio parorama sobre la realidad de la región murciana durante el último siglo de la Edad Media e, incluso, analizar las repercusiones que tuvo para el territorio murciano la desaparición del reino nazarí de Granada tras su capitulación en 1492.With the end of the great conquest of the 13th century, the frontier with the recentIy founded Kingdom of Granada remained practically stagnant. The present article studies the situation in the Murcia territory and the effect the presence of this neigthboring border had in the area. A reference is made to the organization of the territory and to the concentration of populations in large centers like Lorca, Caravaca, and Cehegín among others. It al so alludes to the function the Murcian border served as a place of polítical refuge in relation to the internal disputes that defined the region during the 15th century. All of this allows the author to present a panorama of the reality of the Murcian region during the last century of the Middle Ages, and to analyze the repercussions that the disappearance of the Nazarí Kingdom of Granada had on the Murcian territory afier its surrender in 1492

Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: a case report

<p>Abstract</p> <p>Introduction</p> <p>An imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation.</p> <p>Case presentation</p> <p>A 33-year-old woman (G3, P3) presented referring intense dysmenorrhea and intermenstrual spotting since her third cesarean delivery, 1 year before. A cesarean section dehiscence with utero-peritoneal fistula was diagnosed by transvaginal ultrasound.</p> <p>Conclusion</p> <p>We can conclude that transvaginal two-dimensional power Doppler and three-dimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.</p

Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study

Background Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. Methods EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. Results A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). Conclusion Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.SEPA

The value of minilaparotomy for total hysterectomy for benign uterine disease: A comparative study with conventional Pfannenstiel and laparoscopic approaches

<p>Abstract</p> <p>Background</p> <p>The aim of this paper is to review and compare the results obtained using the Pfannenstiel, laparoscopy and minilaparotomy approaches for total hysterectomy procedure in relation to benign uterine diseases.</p> <p>Methods</p> <p>A retrospective data analysis was performed on 165 patients who underwent hysterectomy for benign uterine diseases at our centre during the period 2004 to 2006.</p> <p>Findings</p> <p>The minilaparotomy procedure was the fastest procedure with a mean time of 73.4 minutes (range: 67.85 to 78.94 minutes, p < 0.001). Hospital stay was shortest for laparosopic procedure (mean time: 3.24 days, range: 2.86 to 3.61 days) (p < 0.001). The rate of intraoperative and postoperative complications were not statistical different among three procedures.</p> <p>Conclusion</p> <p>The minilaparotomy procedure offers a minimally invasive option for total hysterectomy due to benign uterine disease.</p

Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis

Background: Transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) are used for the clinical diagnosis of adenomyosis. Objectives: To compare the diagnostic accuracy of TVS and MRI for the diagnosis of adenomyosis.Search Strategy: A search of studies was performed in five databases comparing TVS and MRI for the diagnosis of adenomyosis from January 1990 to May 2022.Selection Criteria: Studies were eligible if they reported on the use of TVS and MRI in the same set of patients. The reference standard must be pathology (hysterectomy). Data Collection and Analysis: The quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity of both techniques were estimated and compared. Main Results: Six studies comprising 595 women were included. The risk of bias of patient selection was high in three studies. The risk of bias for index tests and reference test was low. Pooled estimated sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for TVS were 75%, 81%, 3.9, and 0.31, respectively. These figures for MRI were 69%, 80%, 3.5, and 0.39, respectively. No statistically significant differences were found (p= 0.7509). Heterogeneity was high. Conclusions: MRI and TVS have similar performances for the diagnosis of adenomyosis

Recurrence Rate and Morbidity after Ultrasound-guided Transvaginal Aspiration of Ultrasound Benign-appearing Adnexal Cystic Masses with and without Sclerotherapy: A Systematic Review and Meta-analysis

To determine the pooled recurrence rate of benign adnexal masses/cysts (namely simple cyst, endometrioma, hydrosalpinx, peritoneal cyst) after transvaginal ultrasound-guided aspiration, with or without sclerotherapy

Ovarian Adnexal Reporting Data System (O-RADS) for Classifying Adnexal Masses: A Systematic Review and Meta-Analysis

In this systematic review and meta-analysis, we aimed to assess the pooled diagnostic performance of the so-called Ovarian Adnexal Report Data System (O-RADS) for classifying adnexal masses using transvaginal ultrasound, a classification system that was introduced in 2020. We performed a search for studies reporting the use of the O-RADS system for classifying adnexal masses from January 2020 to April 2022 in several databases (Medline (PubMed), Google Scholar, Scopus, Cochrane, and Web of Science). We selected prospective and retrospective cohort studies using the O-RADS system for classifying adnexal masses with histologic diagnosis or conservative management demonstrating spontaneous resolution or persistence in cases of benign appearing masses after follow-up scan as the reference standard. We excluded studies not related to the topic under review, studies not addressing O-RADS classification, studies addressing MRI O-RADS classification, letters to the editor, commentaries, narrative reviews, consensus documents, and studies where data were not available for constructing a 2 × 2 table. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated. The quality of the studies was evaluated using QUADAS-2. A total of 502 citations were identified. Ultimately, 11 studies comprising 4634 masses were included. The mean prevalence of ovarian malignancy was 32%. The risk of bias was high in eight studies for the "patient selection" domain. The risk of bias was low for the "index test" and "reference test" domains for all studies. Overall, the pooled estimated sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of the O-RADS system for classifying adnexal masses were 97% (95% confidence interval (CI) = 94%-98%), 77% (95% CI = 68%-84%), 4.2 (95% CI = 2.9-6.0), 0.04 (95% CI = 0.03-0.07), and 96 (95% CI = 50-185), respectively. Heterogeneity was moderate for sensitivity and high for specificity. In conclusion, the O-RADS system has good sensitivity and moderate specificity for classifying adnexal masses

The Bañolas human mandible revisited (Gerona, Spain)

La mandíbula de Bañolas, descubierta en 1887 en Bañolas (Gerona, España), es un fósil humano sobre cuya asignación taxonómica no hay aún consenso. En diferentes estudios ha sido incluida dentro de Homo neanderthalensis {King, 1864} (Hernández-Pacheco & Obermaier, 1915; Sánchez, 1993), dentro de los ante-neandertales (de Lumley, 1971-72) y dentro de los ante-würmienses (Roth & Simon, 1993). Recientemente, Daura y colaboradores (Daura et al., 2005), en su artículo sobre la mandíbula fósil de la Cova del Gegant, sugieren que la mandíbula de Bañolas no presenta caracteres neandertales y que, dada su cronología, podría haber pertenecido a un Homo sapiens {Linneo, 1758}. Este estudio trata de arrojar luz sobre la cuestión de la asignación taxonómica de la mandíbula de Bañolas. Para ello se han utilizado caracteres morfológicos discretos que permiten discriminar entre las especies H. heidelbergensis {Schoetensack, 1908}, H. neanderthalensis y H. sapiens. La conclusión del trabajo es que los estados de los caracteres que presenta la mandíbula de Bañolas son, en su mayor parte, más frecuentes en H. sapiens que en las otras dos especies tenidas en cuenta.Since the discovery of a fossil human mandible in 1887 near the city of Bañolas (Gerona, Spain), there has been considerable disagreement among scholars as to its taxonomic allocation. In different studies the specimen has been included within Homo neanderthalensis {King, 1864} (Hernández-Pacheco & Obermaier, 1915; Sánchez, 1993), ante-Neandertals (de Lumley, 1971-72) or an ante-würmian (Roth & Simon, 1993) species. More recently, the Bañolas mandible has been argued to lack derived Neandertal traits (Daura et al., 2005). Although the mandible was found in a quarry of travertine, its exact location is unknown. Some patches of travertine adhered to the specimen have provided a geochronological age range between 17,6 to 110 kyr (Berger & Libby, 1966¸ Yokoyama et al., 1987; Julià & Bischoff, 1991; Grün et al., 2006). The only direct dating of the mandible yielded an age of 66 ± 7 kyr B.P. (Grün et al., 2006). After a recent examination of the original specimen, a number of morphological traits of this mandible has been described and compared with information from the literature regarding H. heidelbergensis {Schoetensack, 1908}, H. neanderthalensis and both fossil and extant H. sapiens {Linneo, 1758} mandibles. These characters have been considered to be of taxonomical significance to discriminate between these three species (see below for references). Despite the fragmentary condition of the Bañolas mandible, a considerable number of morphological traits can be evaluated: presence/absence of the mental trigone (Schwartz & Tattersall , 2000), shape of the anterior basal corpus (Quam & Smith, 1998), position of the digastric fossa (de Lumley, 1973), number, size and location of the mental foramen (Trinkaus, 1993), presence/absence of the retromolar space and inclination of the retromolar triangle (Franciscus & Trinkaus, 1995; Rosas, 2001), shape of the mandibular foramen (Smith, 1978), size and shape of the medial pterygoid tubercle (Antón, 1996), relative position between the condyle and the ascending ramus plane (Rosas, 2001; Nicholson & Harvati, 2006; Trinkaus, 2006), dimensions of the submental incisure (Mounier et al., 2009), location and trajectory of the mylohyoid line (Mounier et al., 2009), size of the alveolar plane (Mounier et al., 2009), shape of the gonion (Creed-Miles et al., 1996) and relative position of the lateral prominence to the dentition (Rosas, 2001; Mounier et al., 2009). The state of these characters in the Bañolas mandible is as follow: absence of mental trigone (but slight evidences of a possible mental fossa and a possible central keel) (Fig. 1), triangular anterior basal corpus shape (Figs. 1 and 3), disgastric fossa located in the posterior face of the symphysis (Figs. 1 and 3 ), a single small mental foramen placed in the upper half of the corpus and below the P4 (Fig. 2), absence of retromolar space and an oblique retromolar triangle relative to the alveolar margin (Figs. 2 and 6), small and not lib-shaped medial pteriogoid tubercle (Fig. 5), medially placed condyle relative to the ascending ramus plane (Fig. 4), large dimensions of the submental incisure (Fig. 2), mylohyoid line that starts near the M3 and follows obliquely to the alveolar margin (Fig. 4), not large (wide) alveolar plane (Fig. 6), rounded (not truncated) gonion (Figs. 2 and 4) and anteriorly placed lateral prominence (M2 and M2/ M3 septum) (Fig. 2). Regarding the mandibular foramen, it seems to present a lingula, it could confirm the presence of a normal mandibular foramen type and it would discard the possibility of an H-O mandibular foramen type (Smith, 1978) (Fig. 5). Except for the large submental incisure and the absence of mental trigone, the state of all these characters is more frequent in Homo sapiens specimens (de Lumley, 1973; Smith, 1978; Trinkaus, 1993; Franciscus & Trinkaus, 1995; Antón, 1996; Creed-Miles et al., 1996; Quam & Smith, 1998; Rosas, 2001; Nicholson & Harvati, 2006; Trinkaus, 2006; Mounier et al., 2009). The large submental incisure is a characteristic trait of Homo heidelbergensis and the absence of mental trigone is a plesiomophic character shared by Homo neanderthalensis, Homo heidelbergensis and some upper Pleistocene Homo sapiens individuals (Schwartz & Tattersall , 2000). On the view of this work our conclusion is that the Bañolas mandible shows neither derived Neandertal traits nor clear affinities to H. heidelbergensis. On the contrary, this specimen bears a greater resemblance to the H. sapiens mandibles.Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasTRUEpu

Extra-Gynecological Pelvic Pathology: A Challenge in the Differential Diagnosis of the Female Pelvis

Ultrasound technology with or without color Doppler allows a real-time evaluation of the entire female pelvis including gynecologic and non-gynecological organs, as well as their pathology. As ultrasound is an accurate tool for gynecological diagnosis and is less invasive and less expensive than other techniques, it should be the first imaging modality used in the evaluation of the female pelvis. We present a miscellany of non-gynecological pelvic images observed during the realization of gynecological ultrasound. Transvaginal and transabdominal ultrasound is the first choice among diagnostic techniques for the study of the female pelvis, providing information about gynecological and extra-gynecological organs, allowing for an orientation toward the pathology of a specific organ or system as well as for additional tests to be performed that are necessary for definitive diagnosis