The Mayer-Rokitansky-Küstner-Hauser syndrome.

OBJECTIVES: To describe the case of a woman affected by a rare syndrome, known as Mayer-Rokintansky-Küstner-Hauser syndrome (MRKH), characterized by congenital absence of uterus and upper vagina, often found associated with renal agenesia or other renal malformations, which in this case, presented as the prime feature of the disease, with left pelvic pain due to a hydronephrosis of the right cross ectopic kidney. MATERIAL AND METHODS: A kidneys ultrasound and an abdominal computerized tomography were executed to find the cause of the left pelvic pain referred by the woman and associated too, with a primary amenorrhea, with a normal 46, XX karyotypes and normal external genitalia. RESULTS: Examination and diagnostic images revealed an absence of the upper vagina, uterine agenesia, asymmetric hypoplasia of the buds associated with left kidney agenesia and cross-ectopia of the right kidney which was visualized in the left iliac fossa. CONCLUSIONS: Treatment is usually delayed until the patient is ready to start sexual activity. It is based on the surgical creation of a neovagina. In addition it is important to manage the psychological symptoms indeed in a young woman, the discovery of a malformation involving reproductive organs could be cause of anxiety about her femininity and her physical image. Everyday improvement in medical technology offers to such a woman, the possibility to satisfy her necessity to be mother through the use of the modern procreating assisted technology, bypassing the absence of the inner genital tract. In those cases it is also important to investigate the contemporary association not only of renal defects but also of cervico-thoracic and hearing, digital anomalies. When all those malformations are presented, the term MURCS (Müllerian Renal Cervical Somite) is used to define the most severe form of the disorder

Comparison of standard reading and computer aided detection (CAD) on a national proficiency test of screening mammography.

OBJECTIVE: To evaluate the role of computer aided detection (CAD) in improving the interpretation of screening mammograms MATERIAL AND METHODS: Ten radiologists underwent a proficiency test of screening mammography first by conventional reading and then with the help of CAD. Radiologists were blinded to test results for the whole study duration. Results of conventional and CAD reading were compared in terms of sensitivity and recall rate. Double reading was simulated combining conventional readings of four expert radiologists and compared with CAD reading. RESULTS: Considering all ten readings, cancer was identified in 146 or 153 of 170 cases (85.8 vs. 90.0%; chi(2)=0.99, df=1, P=0.31) and recalls were 106 or 152 of 1330 cases (7.9 vs. 11.4%; chi(2)=8.69, df=1, P=0.003) at conventional or CAD reading, respectively. CAD reading was essentially the same (sensitivity 97.0 vs. 96.0%; chi(2)=7.1, df=1, P=0.93; recall rate 10.7 vs. 10.6%; chi(2)=1.5, df=1, P=0.96) as compared with simulated conventional double reading. CONCLUSION: CAD reading seems to improve the sensitivity of conventional reading while reducing specificity, both effects being of limited size. CAD reading had almost the same performance of simulated conventional double reading, suggesting a possible use of CAD which needs to be confirmed by further studies inclusive of cost-effective analysis.