Spectrum of normal intrauterine cavity sonographic findings after first-trimester abortion.

OBJECTIVE: To characterize the sonographic appearance of the uterine cavity after uncomplicated first-trimester abortion. METHODS: Women who underwent uterine evacuation for first-trimester abortion were referred for endovaginal sonographic examination within the week after the procedure. Special attention was directed to characterizing the intrauterine cavity. Demographic and clinical parameters were collected. A repeated postmenstrual examination was carried out in selected cases. RESULTS: In all, 57, 10, and 7 sonographic examinations were performed after termination of pregnancy, incomplete (spontaneous) abortion, and missed abortion, respectively. Fifty-seven (77%) of the 74 examinations showed considerable amounts of intrauterine content with various echogenicities (anteroposterior thickness range, 7-61 mm). No association could be documented between the pattern of appearance and gravidity, parity, gestational age, or type of abortion procedure. All postmenstrual reevaluations of patients with excessive amounts of intrauterine material at the initial examination (n = 7) showed empty intrauterine cavities. CONCLUSION: Within the week after first-trimester abortion, the uterine cavity is seldom empty. Thick heterogeneous material is an expected finding after examination. By being familiar with this normal range of appearances, clinicians can avoid unnecessary repeated invasive evacuation procedures. A follow-up sonographic evaluation during the follicular phase of the next menstrual cycle is recommended to confirm the absence of retained products of pregnancy.

Absence of estrogen receptor-beta expression in metastatic ovarian cancer.

OBJECTIVE: To evaluate the expression of estrogen receptor (ER)alpha and ERbeta mRNA and protein in normal ovarian tissue and primary and metastatic tumors. METHODS: Estrogen receptor alpha and ERbeta expression was studied in normal ovarian biopsies (n = 9) and primary (n = 8) and metastatic ovarian epithelial cancers (n = 8). Ovarian tissue was collected from surgical samples. Estrogen receptor alpha and ERbeta mRNA expression was compared by coamplification of the mRNA of the ERs. Expression was confirmed at the protein level by Western blot analysis using antibodies specific for each receptor. RESULTS: Among eight primary ovarian cancer samples, three had only ERalpha, two had only ERbeta, and three had both. All eight metastatic ovarian cancer tissues expressed only ERalpha mRNA and protein. Biopsies from normal ovaries had ERalpha and ERbeta mRNA and protein. Two of the ovarian epithelial cancer samples were paired and showed the same results. CONCLUSION: We found varying amounts of ERalpha and ERbeta in normal ovaries, lower levels of ERbeta expression in ovarian epithelial cancer primary tumors, and only ERalpha in metastatic tumors. Our findings indicate that a fundamental difference might exist between primary and metastatic cells, which could be caused by intrinsic or extrinsic factors that regulate ER gene expression.

Red blood cell zinc protoporphyrin measurement for assessment of peripartum iron deficiency.

OBJECTIVE: To study the effectiveness of the rapid red blood cell zinc protorphyrin (RBC-ZPP) test for the detection of women with iron-deficiency anemia in the peripartum period. DESIGN: Blood was drawn prospectively from 150 healthy parturient women upon admission to the labor and delivery room and 72 hours after delivery. Concentration of RBC-ZPP was measured and correlated with hemoglobin level (p = 0.001), mean corpuscular volume (p = 0.002), hematocrit (p = 0.0001), platelet count (p = 0.002), and serum iron (p = 0.0001), serum ferritin (p = 0.0001) and serum transferrin (p = 0.0001) concentrations. RESULTS: RBC-ZPP concentration showed a significant increase from pre-delivery to 72 hours post-delivery. This change correlated significantly with the changes in all the other parameters studied. CONCLUSION: The RBC-ZPP test is a reliable, rapid, easy-to-perform, and inexpensive method of screening low-risk women, after uneventful vaginal delivery, for iron deficiency.

Abnormal sonographic endometrial findings in asymptomatic postmenopausal women: possible role of antihypertensive drugs.

OBJECTIVE: The purpose of this study was to evaluate the possible effect of the antihypertensive agent nifedipine (a calcium channel antagonist) on the endometrium of asymptomatic menopausal women by using transvaginal sonography, hysteroscopy, and endometrial sampling. DESIGN: Eighty-five asymptomatic postmenopausal women with an ultrasonographically detected endometrial thickness of more than 7 mm were examined. The study group comprised 43 women treated with nifedipine (30-60 mg/day) for mild to moderate hypertension for at least 1 year, and the control group comprised 42 normotensive women. All participants underwent transvaginal sonography, hysteroscopy, and, if necessary, endometrial biopsy. RESULTS: Of the 85 patients, 53 were found to have atrophic endometrium, 36 (83.7%) in the study group and 17 (40.5%) in the control group. The difference between the groups was statistically significant (p < 0.05). There were three cases of hyperplasia and three cases of carcinoma of the endometrium, with similar rates in the two groups. CONCLUSIONS: Among asymptomatic postmenopausal patients with sonographically thickened endometrium, atrophic endometrium was found to be significantly more prevalent in those using calcium channel antagonists to control hypertension than in those who were normotensive controls. The presence of endometrial hyperplasia and malignancy in the study group underscores the importance of meticulous endometrial evaluation whenever sonographically thickened endometrium is encountered.