Clinical usefulness of contrast-enhanced color Doppler ultrasonography in invasive and noninvasive gestational trophoblastic diseases: a preliminary study.

OBJECTIVE: To examine the usefulness of contrast-enhanced color Doppler ultrasonography (CDU) in differentiating between invasive and noninvasive gestational trophoblastic disease (GTD). STUDY DESIGN: In 23 patients with findings suggestive of GTD by transvaginal gray-scale ultrasonography, the presence or absence of blood flow within uterine lesions was assessed by contrast-enhanced CDU using Levovist (Schering, Berlin, Germany) microbubble contrast agent. Intratumoral blood flow waveforms were analyzed using resistance indices. Tumor size in each invasive or malignant GTD was assessed by magnetic resonance imaging. RESULTS: Intratumoral blood flow was detected in all invasive or malignant GTDs (7/7: 5 invasive moles, 1 choriocarcinoma and 1 placental site trophoblastic tumor), whereas it was not seen in any noninvasive GTD (0/16:10 complete moles, 5 partial moles and 1 exaggerated placental site) (p <0.0001). A marked increase in uterine vascularity was thus shown in all invasive or malignant GTDs following enhancement. In small invasive moles (<2 cm) in the uterine myometrium, color flow was remarkably increased by contrast-enhanced CDU. Intratumoral blood flow waveforms showed low resistance indices in all invasive and malignant GTDs. CONCLUSION: Contrast-enhanced CDU may be useful in differentiating invasive or malignant GTDs from noninvasive GTDs. By enhancing color flow, this minimally invasive approach may be helpful for detecting small invasive GTD lesions within the uterine myometrium.

The efficacy of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas.

AIM: The aim of this study was to investigate the influence of preoperative hormonal therapy before laparoscopic cystectomy of ovarian endometriomas. We identified differences in follicle loss and surgical difficulties with or without preoperative hormonal therapy. METHODS: Ninety-six patients with ovarian endometrioma underwent a laparoscopic cystectomy. Patients were divided into three groups: control group A (53 patients, 57 cysts) with no preoperative hormonal therapy; group B (34 patients, 40 cysts) who received gonadotropin-releasing hormone agonist therapy; and group C (9 patients, 11 cysts) who received danazol therapy before surgery. The medical and videotape records of all patients were retrospectively reviewed. The specimens of endometriomas were histologically evaluated. RESULTS: Mean diameters of endometriomas before hormonal therapy in groups B and C were significantly greater than those in the control group. There were no significant differences in the following: the mean diameter of removed cysts, the revised-American Society of Reproductive Medicine scores, the number of capsules containing follicle(s), and the mean number of follicles attached to a cyst. However, the number of capsules showing fibrosis significantly increased in the preoperative hormonal therapy groups (P < 0.001). Furthermore, the mean operation time of the preoperative hormonal groups was significantly longer than that of the control group (P < 0.01, P < 0.001). CONCLUSION: Our data suggested that preoperative hormonal therapy reduced the size of endometriomas. However, with similar revised-American Society of Reproductive Medicine scores, preoperative hormonal therapy did not contribute to the reduction of the loss of ovarian follicles. Fibrosis resulting from hormonal therapy appears to be responsible for these observations.

Changes in lipid metabolism in postmenopausal Japanese women using hormone therapy evaluated by capillary isotachophoresis: a pilot study.

OBJECTIVE: The aim of this study was to clarify the changes in lipid metabolism in postmenopausal Japanese women during continuous combined hormone therapy (HT) in detail by using capillary isotachophoresis (cITP). DESIGN: Twenty-three postmenopausal Japanese women with climacteric symptoms were recruited. Blood samples were collected from all participants before HT and after 3 and 6 months of HT, and changes in total cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and apolipoprotein (apo) A-I, apoB, and lipoprotein(a) were assessed. The same blood samples were analyzed for charge-based lipoprotein subfractions using cITP. RESULTS: Total cholesterol (-8.5%), LDL-cholesterol (-16.2%), and lipoprotein(a) (-25.5%) decreased and apoA-I (9.5%) increased significantly from the baseline level at 6 months after starting continuous combined HT. HDL-cholesterol increased nonsignificantly (+2.4%). cITP revealed that the fast HDL subfraction (+24.7%), which contains apoA-I and may be antiatherogenic, significantly increased. Conversely, the fast LDL subfraction (+14.4%), which may possess atherogenic potential, increased during HT. CONCLUSIONS: The changes in lipid metabolism in postmenopausal Japanese women receiving HT are inconclusive regarding atherogenicity, ie, it increased fast HDL and simultaneously increased fast LDL. cITP is useful for clarifying the changes in lipid metabolism during HT.

The sonohysterographic difference in submucosal uterine fibroids and endometrial polyps treated by hysteroscopic surgery.

OBJECTIVE: The purpose of this study was to clarify the differences in sonohysterographic (SHG) findings between submucosal uterine fibroids and endometrial polyps treated by surgical hysteroscopy. METHODS: Eighty patients with intrauterine benign masses without any endometrial cytologic atypia were examined by SHG before undergoing surgical hysteroscopy. The SHG images in these masses were assessed for the following characteristics: size, number, location, echogenicity, and degree of projection into the uterine cavity. The SHG findings were then compared with their hysteroscopic findings. The feeding vessels into these masses were also assessed by transvaginal color Doppler sonography in 26 of the 80 patients. RESULTS: In all 80 patients, 47 histopathologically had submucosal fibroids, whereas the remaining 33 had endometrial polyps. Masses measuring greater than 20 mm were significantly more frequently fibroids than polyps (P < .01). Homogeneous hyperechoic masses were significantly seen in polyps (93.9% [31/33]; P < .01) but not in any fibroids except for 1 case. Multiple feeding vessels were significantly found in fibroids (12/15; P < .01), whereas they were not found in any of the 11 polyps examined. The location and degree of projection into the uterine cavity of these masses as assessed by SHG were consistent with their hysteroscopic findings in 78 (97.5%) of 80 patients. The foci of endometrial hyperplasia were significantly found in 5 (15.2%) of 33 polyps (P < .01), whereas no such tissues were obtained in any fibroids. CONCLUSIONS: Intracavitary fibroids tend to be larger than the polyps, and homogeneous hyperechoic masses in the uterine cavity observed by SHG are highly suggestive of endometrial polyps.