Validity of Endometrial Cavity Length on 3D Pelvic Ultrasound before Endometrial Ablation.

OBJECTIVES: This study aimed to compare endometrial cavity length measurements obtained by preoperative three-dimensional (3D) reconstruction of coronal images on pelvic ultrasound with intraoperative endometrial cavity measurements obtained in advance of Minerva endometrial ablation. METHODS: This was a retrospective cohort study of 41 individuals who underwent a Minerva endometrial ablation between August 1, 2018 and March 15, 2022 at a single academic medical center. Patients were excluded if they had an in-clinic ablation or no ultrasound with 3D uterine volume within 180 days before surgery. Physician sonologists measured the endometrial cavity length using 3D coronal reconstruction of the cavity. Two measurements were obtained by separate physicians who were blinded to intraoperative values. Intraoperative endometrial cavity lengths were obtained from operative reports. A Bland-Altman plot was used to evaluate the agreement of intraoperative and ultrasound measurements. RESULTS: The mean intraoperative endometrial cavity length (50.7 ± 7.8 mm) was greater than the mean endometrial cavity length by 3D coronal reconstruction of pelvic ultrasound (36.1 ± 6.2 mm, P < 0.0001). The average difference between intraoperative and ultrasound measurements of cavity length was 14.6 ± 9.0 mm. The agreement between measurements was poor (Lin's concordance correlation coefficient 0.06). Using a Bland-Altman plot, the limits of agreement (-3.1 to 32 mm) exceeded the a priori acceptable limits of agreement (-10 to 10 mm). CONCLUSIONS: Our findings suggest that preoperative coronal endometrial cavity length measurements by ultrasound are not a valid substitute for intraoperative measurements before Minerva ablation.

Bone mineral status in pediatric heart transplant recipients: a retrospective observational study of an "at risk" cohort.

There is a paucity of literature assessing the burden of bone loss in PHT recipients. We sought to describe the bone mineral status in PHT recipients by doing a retrospective medical record review of those who underwent evaluation of BMD when clinically indicated. Data collected included patient demographics, BMD evaluations, serum calcium, phosphorus, alkaline phosphatase, cumulative steroid dose, osseous complications and their management. Of 149 PHT recipients, 26 underwent BMD evaluation. This evaluation was done at a median of 3.4 yrs after PHT. There total serum calcium, phosphorus and alkaline phosphatase were similar at transplant and BMD study. The median BMD Z-scores were: whole body -0.09 (1.5 to -5.13) and lumbar spine -1.1 (1.5 to -5.16). Bone loss (Z-score <-1) was present in 14 (53.8%). Three patients had spinal fractures and/or avascular necrosis of various bones. Treatment included calcitrol and bisphosphonates; and vertebroplasty for spinal fracture. Bone loss was present in a significant proportion of PHT recipients and may be associated with fractures and avascular necrosis. More than half of our "at risk" cohort had bone loss. Careful surveillance of these patients should be performed to prevent morbidity.

Familial Mediterranean Fever: An Unusual Case Presentation.

BACKGROUND: Familial Mediterranean Fever is a heritable illness typically characterized by recurrent fevers and serositis. Triggers of this illness include many things, such as cold or stress. CASE: This case describes a teenager who initially presented to the gynecologist office because of recurrent fevers with menses. Because she only had symptoms with menses, was healthy between attacks, and met the Livneh criteria, treatment with colchicine and combined oral contraceptive pills was initiated, with improvement of her symptoms. SUMMARY AND CONCLUSION: There are multiple etiologies for febrile illness during menses, and one should consider familial Mediterranean fever as a possible cause of cyclic fevers.