Prediction of chronic endometritis using 2D and 3D transvaginal ultrasound examination in infertile women

Background: Chronic endometritis is a pathology of continuous and hidden inflammatory process characterized by the infiltration of plasma cells into the endometrial stroma. Transvaginal bi-dimensional ultrasonography is in need to be evaluated in prediction of chronic endometritis in women with delayed pregnancy or infertility as a non-invasive, cheap, acceptable, and safe tool of diagnosis. Previously, 3D ultrasonography had been described as a novel for diagnosis of chronic endometritis and correlation of the images with hysteroscopic view results. Objectives were to predict the presence of chronic endometritis in infertile women during their reproductive age through examination of the uterine cavity by 2D and 3D transvaginal sonography to elicit proposed ultrasonographic signs of endometritis.Methods: This observational prospective study took place at Shatby university hospital, Alexanderia universtiy and was done on two hundred infertile women. Women were assigned for ultrasonographic evaluation as a part of pre-treatment assessment. Detailed history was taken from all the patients included in the study. General examination and routine laboratory investigations were done according to hospital protocol. All patients were asked to do ultrasound examination immediately postmenstrual and at the time of ovulation. We used 2D transvaginal ultrasound to predict chronic endometritis, we searched for 1) presence of persistent endometrial focal or diffuse thickening postmenstrual, 2) presence of focal echogenic foci in the triple line endometrium during ovulation. The 3D ultrasonography was done as confirmatory examination. Office hysteroscopy as the main method for diagnosis of endometritis was performed to all patients either after menses if the first sign was detected or at the time of ovulation if the second sign was detected.Results: The combination of persistent endometrial shreds and/or endometrial focal thickening or echogenicity can significantly predict presence of endometritis as the sensitivity and specificity of the combination were 94.90 and 81.37, respectively.Conclusions: Bi-dimensional ultrasonography done to infertile women at 2 phases of the menstrual period can predict the presence of chronic endometritis as a subtle cause of infertility and might be an indication for hysteroscopic evaluation for these patients

Evaluation of the role of the hystrosalpingography in prediction of endometriosis in infertile females

Background: Hysterosalpingography is the testing the patency of the tubes and the uterine cavity by injecting urographin inside them. The purpose in this study was to evaluate 2 signs in hysterosalpingography (higher position of one or both tubes and S or C shape in the course of one or both tubes) in prediction of endometriosis. Methods: This was prospective cohort study that was done in El-Shatby Maternity University Hospital, Alexandria University. The study included eighty six infertile women who were assigned to do laparoscopy.  Recent hysterosalpingography was done within 3 months period before laparoscopy and comments were done on the position and S or C shape in the course of the tube then laparoscopy was done and document all findings including presence of endometriosis and biopsy was taken from atypical lesions.Results: All signs show high specificity in prediction of endometriosis although only 2 signs (higher level of left tube and bilateral tubal S or C shape) showed significantly high sensitivity in prediction of endometriosis.Conclusion: Careful examination of the HSG film and searching for the specific signs of endometriosis is a practical and simple method in prediction of endometriosis. These preliminary data suggest that HSG has a role in prediction of endometriosis

Repeated ultrasound guided local infiltration of methotrexate in persistent gestational trophoblastic disease with myometrial invasion: case series and review of literature

Gestational trophoblastic disease is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. An invasive mole is a hydatidiform mole that has grown into the muscle layer of the uterus. Invasive vesicular moles can develop from either partial or complete moles, but complete moles become invasive much more often than do partial moles. Invasive moles develop in a little less than 20% of women who have had a complete mole evacuated. Treatment of invasive mole is classically by giving systemic chemotherapy. Objectives of current study were to evaluate the effect of repeated local methotrexate injection in treatment of invasive mole. Cases with invasive mole assigned for local injection of 50 mg methotrexate in 10 cm normal saline using local injection in the myometrium under transvaginal ultrasound guidance. Follow up weekly till negative results are obtained. All cases showed rapid decrease of the level of b-hCG level after local injection and showed negative hormone results within 6 weeks after injection. Local methotrexate intra-myometrial local injection therapy has successful results in cases with persistent invasive hydatidiform mole and should be tried before referring them for systemic therapy

The Search for a New Theory of Sustainable Architectural Design: Breathing Architecture

To maintain the reduction in fuel consumption and the need to modify the techniques concerning climate change new ideas for example “Parisian worker gardens”, New York’s “community gardens”, and “vegetable squares” of Muscovite, come into the picture. The city aims to produce more clean energy than it consumes within fifteen years for a positive energetic assessment. The city plans to shift more towards renewable energies for example photovoltaic cells, biomass, green architecture such as walls and roofs, etc. The new architecture should also follow these green technologies and methods. Methodology—The methodology of this paper is based on a qualitative research format for findings and results, depending on: Data collection, Data Analysis, Theoretical analysis and analytical cases studies integrating the interdisciplinary fields of green technologies and sustainability. Thus producing a new language of architecture based on the dynamic relation among materials, structures and finally a new spatial idea. Empirical application and study. Besides rational comparisons and conclusions

The Search for a New Theory of Sustainable Architectural Design: Breathing Architecture

To maintain the reduction in fuel consumption and the need to modify the techniques concerning climate change new ideas for example “Parisian worker gardens”, New York’s “community gardens”, and “vegetable squares” of Muscovite, come into the picture. The city aims to produce more clean energy than it consumes within fifteen years for a positive energetic assessment. The city plans to shift more towards renewable energies for example photovoltaic cells, biomass, green architecture such as walls and roofs, etc. The new architecture should also follow these green technologies and methods. Methodology—The methodology of this paper is based on a qualitative research format for findings and results, depending on: Data collection, Data Analysis, Theoretical analysis and analytical cases studies integrating the interdisciplinary fields of green technologies and sustainability. Thus producing a new language of architecture based on the dynamic relation among materials, structures and finally a new spatial idea. Empirical application and study. Besides rational comparisons and conclusions

Chromohysteroscopy after failed intracytoplasmic sperm injection

Background: ICSI is the injection of a single sperm directly into the cytoplasm of the oocyte (ICSI). The failure to achieve pregnancy after ICSI has been studied over many years to reach the possible and preventable causes to avoid another failure. The aim of this study was to assess the value of using Chromohysteroscopy as a part of the work up of cases with one or more failed ICSI. The Ultimate goal is to detect the possible endometrial abnormalities and /or endometritis.Methods: Prospective cohort study was carried out with total of 50 infertile women recruited from infertility clinic in Elshatby Maternity University Hospital, Alexandria University, Egypt. Cases were allocated in 2 groups with 25 cases in each group. The first group included cases that had a failed trial of ICSI. The second group included control cases who were seeking for fertility treatment with no previous history of ICSI or any uterine surgery or anatomical abnormalities. In the postmenstrual period, Chromohysteroscopy was done by the same surgeon and documentation of all findings in the cavity and presence of endometritis.Results: There was a significant increase in the incidence of endometritis among the study group 68% in comparison to 16% in the control group.Conclusions: In this study endometrial dying with methylene blue at hysteroscopy improve the detection of chronic endometritis