Bias associated with delayed verification in test accuracy studies: accuracy of tests for endometrial hyperplasia may be much higher than we think!

BACKGROUND: To empirically evaluate bias in estimation of accuracy associated with delay in verification of diagnosis among studies evaluating tests for predicting endometrial hyperplasia. METHODS: Systematic reviews of all published research on accuracy of miniature endometrial biopsy and endometr ial ultrasonography for diagnosing endometrial hyperplasia identified 27 test accuracy studies (2,982 subjects). Of these, 16 had immediate histological verification of diagnosis while 11 had verification delayed > 24 hrs after testing. The effect of delay in verification of diagnosis on estimates of accuracy was evaluated using meta-regression with diagnostic odds ratio (dOR) as the accuracy measure. This analysis was adjusted for study quality and type of test (miniature endometrial biopsy or endometrial ultrasound). RESULTS: Compared to studies with immediate verification of diagnosis (dOR 67.2, 95% CI 21.7–208.8), those with delayed verification (dOR 16.2, 95% CI 8.6–30.5) underestimated the diagnostic accuracy by 74% (95% CI 7%–99%; P value = 0.048). CONCLUSION: Among studies of miniature endometrial biopsy and endometrial ultrasound, diagnostic accuracy is considerably underestimated if there is a delay in histological verification of diagnosis

Correção cirúrgica da esotropia progressiva do alto míope pela técnica de Yamada: relato de dois casos Surgical correction of progressive high myopic esotropia by Yamada's technique: report of two cases

A "esotropia fixa progressiva" se apresenta como um quadro de esotropia progressiva, em adultos altos míopes, que aumenta até que os olhos fiquem fixos numa esotropia de grande ângulo, geralmente associada a hipotropia, e que tem fracos resultados cirúrgicos. O objetivo deste trabalho é descrever a abordagem cirúrgica de 2 pacientes com "esotropia fixa adquirida progressiva" que foram operados segundo a técnica de Yamada (hemitransposição dos retos lateral e superior), e obtiveram bom resultado pós-operatório.<br>"Progressive esotropia fixus" is a disease present in high myopic patients with a large angle esotropia associated with hypotropia with poor surgical results. This paper has the purpose to describe Yamada's surgical technique (hemitranspositions of the superior rectus and lateral rectus) applied to 2 patients with good surgical results

Minilaparoscopic hysterectomy.

Minilaparoscopic surgery was performed in a 38-year-old woman scheduled for hysterectomy and ovarian cystectomy. Image resolution was similar to that of conventional laparoscopy. There were no intraoperative or postoperative complications. Since it has many advantages and few complications, minilaparoscopy appears to be an attractive way to decrease morbidity associated with conventional laparoscopy. (J Am Assoc Gynecol Laparosc 5(4):97-100, 1998