Quantitative sonoelastography of the uterine cervix prior to induction of labor as a predictor of cervical dilation time.

OBJECTIVE: To evaluate how the approximate Young's modulus of the uterine cervix assessed by quantitative sonoelastography in patients undergoing induction of labor is associated with the cervical dilation time and to evaluate the approximate Young's modulus as a predictor of prolonged cervical dilation time. DESIGN: Cross-sectional study. SETTING: Aarhus University Hospital, Aarhus, Denmark. POPULATION: Term-pregnant women. METHODS: A total of 49 term-pregnant women were included before induction of labor. The approximate Young's modulus of the anterior cervical lip was determined by the use of a reference cap applied on the end of the transvaginal transducer during sonoelastography. MAIN OUTCOME MEASURES: Cervical dilation time during active labor. RESULTS: The approximate Young's modulus was associated with the cervical dilation time during active labor (R(2) log  = 0.24, p < 0.01) and predicted prolonged duration of cervical dilation time (>330 min) with the area under the receiver operating characteristic (ROC) curve of 0.71, sensitivity 74%, and specificity 69%. Equivalent figures for the Bishop's score were R(2) log  = 0.02 (p = 0.37), the area under the ROC curve 0.53, sensitivity 53%, and specificity 46%. For the cervical length measurements the corresponding results were: R(2) log  = 0.02, p = 0.35, area under the ROC curve 0.57, sensitivity 66% and specificity 54%. The intra-observer and inter-observer intraclass correlations were 88% and 58%, respectively, with quantitative elastography. CONCLUSIONS: The approximate Young's modulus is superior to the Bishop score and the cervical length measurements concerning the prediction of cervical dilation time and the risk of prolonged dilation time after induction of labor.

Bile acid malabsorption investigated by selenium-75-homocholic acid taurine ((75)SeHCAT) scans: causes and treatment responses to cholestyramine in 298 patients with chronic watery diarrhoea.

BACKGROUND: The liver produces and secretes bile acids into the small intestine. In the small intestine, most of the bile acids are absorbed in the distal ileum with portal vein transportation back to the liver and resecretion (enterohepatic recycling). Increased spillover of bile acids from the small intestine into the colon (bile acid malabsorption) may affect the secretion of colonic water and electrolytes and result in watery diarrhoea. The aim of this study was to investigate the frequency of bile acid malabsorption and treatment responses to cholestyramine with (75)SeHCAT scanning among patients suffering from chronic watery diarrhoea. METHODS: This was a retrospective study that included all patients who received a (75)SeHCAT scan over a five-year period (2004-2009). RESULTS: In total, 298 patients (198 females, 100 men) with a median age of 42 years (range 16-82 years) were investigated. Bile acid malabsorption ((75)SeHCAT retention<15% after seven days) was identified in 201 patients (68%, 95% confidence interval (CI): 62%-73%). Bile acid malabsorption due to ileal dysfunction (Type I) was found in 77 patients, idiopathic bile acid malabsorption (Type II) was found in 68 patients and 56 patients with other conditions had bile acid malabsorption (Type III). Of the 150 patients who were able to take cholestyramine continuously, 108 patients (71%, CI: 63%-78%) reported a positive effect on their bowel habits. CONCLUSIONS: Bile acid malabsorption is a frequent problem in patients with chronic watery diarrhoea. Treatment with bile acid binders was effective regardless of type and severity.