Risk assessment and prediction of occult uterine sarcoma in patients with presumed uterine fibroids before high-intensity focused ultrasound treatment.

OBJECTIVE: To develop a diagnostic model for predicting occult uterine sarcoma in patients with presumed uterine fibroids. MATERIALS AND METHODS: We retrospectively reviewed 41631 patients with presumed uterine fibroids who presented for HIFU treatment in 13 hospitals between November 2008 and October 2023. Of these patients, 27 with occult uterine sarcoma and 54 with uterine fibroids were enrolled. Univariate analysis and multivariate logistics regression analysis were used to determine the independent risk factors for the diagnosis of occult uterine sarcoma. A prediction model was constructed based on the coefficients of the risk factors. RESULTS: The multivariate analysis revealed abnormal vaginal bleeding, ill-defined boundary of tumor, hyperintensity on T2WI, and central unenhanced areas as independent risk factors. A scoring system was created to assess for occult uterine sarcoma risk. The score for abnormal vaginal bleeding was 56. The score for ill-defined lesion boundary was 90. The scores for lesions with hypointensity, isointensity signal/heterogeneous signal intensity, and hyperintensity on T2WI were 0, 42, and 93, respectively. The scores for lesions without enhancement on the mass margin, uniform enhancement of tumor, and no enhancement in the center of tumor were 0, 20, and 100, respectively. Patients with a higher total score implied a higher likelihood of a diagnosis of occult uterine sarcoma than that of patients with a lower score. The established model showed good predictive efficacy. CONCLUSIONS: Our results demonstrated that the diagnostic prediction model can be used to evaluate the risk of uterine sarcoma in patients with presumed uterine fibroids.

Effects of gamma-ray irradiation on material and electrical properties of AlN gate dielectric on 4H-SiC.

This article investigates the radiation effects on as-deposited and annealed AlN films on 4H-SiC substrates under gamma-rays. The AlN films are prepared using plasma-enhanced-atomic-layer-deposition on an n-type 4H-SiC substrate. The AlN/4H-SiC MIS structure is subjected to gamma-ray irradiation with total doses of 0, 300, and 600 krad(Si). Physical, chemical, and electrical methods were employed to study the variations in surface morphology, charge transport, and interfacial trapping characteristics induced by irradiation. After 300 krad(Si) irradiation, the as-deposited and annealed samples exhibit their highest root mean square values of 0.917 nm and 1.190 nm, respectively, which is attributed to N vacancy defects induced by irradiation. Under irradiation, the flatband voltage (Vfb) of the as-deposited sample shifts from 2.24 to 0.78 V, while the annealed sample shifts from 1.18 to 2.16 V. X-ray photoelectron spectrum analysis reveals the decomposition of O-related defects in the as-deposited AlN and the formation of Al(NOx)ycompounds in the annealed sample. Furthermore, the space-charge-limits-conduction (SCLC) in the as-deposited sample is enhanced after radiation, while the barrier height of the annealed sample decreases from 1.12 to 0.84 eV, accompanied by the occurrence of the SCLC. The physical mechanism of the degradation of electrical performance in irradiated devices is the introduction of defects like N vacancies and O-related defects like Al(NOx)y. These findings provide valuable insights for SiC power devices in space applications.

Efficacy and influencing factor analysis of high-intensity focused ultrasound therapy for abdominal wall endometriosis: a case series.

OBJECTIVE: The aim of this retrospective study was to investigate the short-term and long-term efficacy of high-intensity focused ultrasound (HIFU) therapy for abdominal wall endometriosis (AWE) and explore its potential influencing factors. MATERIALS AND METHODS: A total of 80 patients with AWE who underwent HIFU therapy were retrospectively analyzed. Follow-ups were also conducted to evaluate the changes in lesion size and pain relief. Multivariate logistic regression analysis was applied to investigate factors influencing HIFU therapy for AWE. RESULTS: Among the 80 patients with AWE who received HIFU therapy, the effective rates were 76.3%, 80.5%, and 90.5% after 3, 12 and 24 months of follow-up, respectively. Multivariate logistic regression analysis revealed that the AWE lesion diameter and sonication intensity had statistically significant effects on the 3-month and 12-month efficacy of HIFU therapy for AWE, while age, BMI, disease duration, average sonication power and grey-scale changes did not have statistically significant effects. Four patients with AWE experienced recurrence after HIFU therapy, for a three-year cumulative recurrence rate of 6.3%. Furthermore, ten patients required reintervention after treatment, for a five-year cumulative reintervention rate of 13.9%. CONCLUSIONS: This study further confirmed the safety and effectiveness of HIFU therapy for AWE. Factors such as AWE lesion diameter and sonication intensity have been identified as key influencers affecting the short-term and long-term efficacy of HIFU therapy for AWE. The first two years following HIFU therapy constitute crucial periods for observation, and judiciously extending follow-up intervals during this timeframe is advised.

Management of anticoagulation in patients with infective endocarditis.

Infective endocarditis (IE) carries a high risk of vascular complications (e.g., cerebral embolism, intracerebral hemorrhage, and renal infarction), which are correlated with increased early and late mortality. Although anticoagulation is the cornerstone for management of thromboembolic complications, it remains controversial and challenging in patients with IE. An appropriate anticoagulation strategy is crucial to improving outcomes and requires a good understanding of the indication, timing, and regimen of anticoagulation in the setting of IE. Observational studies have shown that anticoagulant treatment failed to reduce the risk of ischemic stroke in patents with IE, supporting that IE alone is not an indication for anticoagulation. In the absence of randomized controlled trials and high-quality meta-analyses, however, current guidelines on IE were based largely on observational data and expert opinion, providing few specific recommendations on anticoagulation. A multidisciplinary approach and patient engagement are required to determine the timing and regimen of anticoagulation in patients with IE, especially in specific situations (e.g., receiving warfarin anticoagulation at the time of IE diagnosis, cerebral embolism or ischemic stroke, intracerebral hemorrhage, or urgent surgery). Collectively, individualized strategies on anticoagulation management of IE should be based on clinical evaluation, available evidence, and patient engagement, and ultimately be developed by the multidisciplinary team.

Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with cervical pregnancy.

OBJECTIVE: To evaluate the effectiveness of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in treating cervical pregnancy. MATERIALS AND METHODS: This is a retrospective study. Seven patients with cervical pregnancy who visited the Third Xiangya Hospital of Central South University from January 2015 to December 2020 were enrolled in the current study. All seven patients were treated with HIFU under conscious sedation. All of them underwent HGSC at an average of 2 ± 1 days (range: 1-3 days) after HIFU. Before the therapy, the patient's clinical characteristics were collected, including duration of amenorrhea, gravidity and parity, the patient history of cesarean section and miscarriage, and the size of the gestational sac. The levels of ß-hCG and hemoglobin in serum were also reviewed. To assess the clinical outcomes of this combined treatment, the suction time of HGSC, bleeding volume, the clearance time of ß-hCG, and the time with returning of menstruation were evaluated. RESULTS: All seven patients (average age: 31 ± 6 years) have experienced amenorrhea (duration range, 48 ± 8 days) before the treatment of HIFU. The average number of pregnancies was four, and the number of deliveries was one. Previous medical history showed six patients had cesarean sections, and five patients have been miscarriages. After HIFU treatment, the fetal heartbeats were stopped in all seven patients based on the diagnosis by doppler ultrasound. The bleeding of gestational tissue decreased significantly. All patients had only mild lower abdominal pain, no fever, intestinal damage, or other complications were reported. The average operation time of operative suction curettage was 21 ± 9 min (range: 9-32 min), and the median bleeding volume was 10 ± 8 mL (range: 2-20 mL). Follow-up observations showed that the menstruations were returned in patients at an average of 38 ± 9 days (range: 30-50 days) after the treatment. The ß-hCG decreased from 41773 ± 32242 mIU/mL to 13101 ± 8454 mIU/mL in 29 ± 10 days after surgery. CONCLUSION: Based on these results with small subjects, we concluded that HIFU combined with HGSC might be an effective and safe treatment for patients with cervical pregnancy.

MRI features and clinical outcomes of unexpected uterine sarcomas in patients who underwent high-intensity focused ultrasound ablation for presumed uterine fibroids.

OBJECTIVE: To investigate the MRI features and clinical outcomes of unexpected uterine sarcomas in patients after high-intensity focused ultrasound (HIFU) ablation for presumed uterine fibroids. MATERIALS AND METHODS: 15,759 consecutive patients who came for HIFU treatment, from November 2008 to September 2019, for presumed uterine fibroids were retrospectively reviewed. All the patients had completed a pre-HIFU MRI. All MRI images were independently analyzed and interpreted by two radiologists in every center. RESULTS: According to the T2WI MRI features of hyperintensity, accompanied by irregular margins, necrosis or cystic degeneration, multi-lobulated lesion with internal septation, 46 patients were suspected to be uterine sarcomas before HIFU. Eleven patients were histologically diagnosed as uterine sarcomas after laparotomy. Among the 15713 patients who received HIFU treatment for presumed uterine fibroids, 8 patients were found to have occult recurrence during the follow-up period, and 6 were confirmed histologically as uterine sarcomas after laparotomy. The incidence rate of uterine sarcomas was 0.108% (17/15759). Among them, 12 cases were low-grade endometrial stromal sarcoma (LG-ESS) and 5 cases were uterine leiomyosarcoma (LMS). No histological dissemination of the sarcoma was detected in patients with unexpected uterine sarcomas. CONCLUSION: Although some MRI features of uterine sarcomas and uterine fibroids overlapped, MRI is valuable in distinguishing between uterine fibroids and uterine sarcomas. HIFU does not seem to cause histological dissemination of the sarcoma, but follow-up visits should be strictly adhered to in order to detect unexpected uterine sarcomas at an early stage and to treat them in a timely manner.

High-intensity focused ultrasound in the management of adenomyosis: long-term results from a single center.

OBJECTIVE: To investigate the long-term clinical outcomes of patients with adenomyosis treated by high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: From June 2012 to January 2020, 2311 patients with adenomyosis were treated with HIFU at our center, 1982 patients who have complete clinical data were retrospectively reviewed. Among the patients who completed the follow-up, 485 were treated with HIFU alone, 289 were treated with HIFU followed by GnRH-a, 255 were treated with HIFU combined with Mirena and 594 were treated with HIFU combined with GnRH-a and Mirena. The dysmenorrhea severity pain score and average menorrhagia severity score before and at 3 months, 6 months, 1 year, 2 years, 3 years and 5 years after HIFU were compared. The adverse effects were recorded. In addition, the efficacy between patients treated with GnRH-a and/or Mirena were compared. RESULTS: After HIFU ablation, the dysmenorrhea severity pain score and the menorrhagia severity score were significantly decreased at each follow-up time point. However, it was observed that as the follow-up time increased, the effective rate of HIFU treatment in improving dysmenorrhea and menorrhagia decreased. The 6 months and 3 years follow-up results showed that the efficacy of HIFU combined with Mirena and HIFU combined with GnRH-a and Mirena were significantly higher than HIFU alone and HIFU combined with GnRH-a (p < 0.05). The major complications were rare. CONCLUSION: HIFU is a safe and effective treatment for patients with adenomyosis. HIFU combined with Mirena or HIFU combined with GnRH-a and Mirena can significantly enhance the long-term treatment results.

A comparative analysis of pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound ablation and laparoscopic myomectomy: a retrospective study.

PURPOSE: The aim of this study was to retrospectively compare and analyze pregnancy outcomes of patients with uterine fibroids after high intensity focused ultrasound (HIFU) ablation and laparoscopic myomectomy (LM). MATERIALS AND METHODS: The study group consisted of 346 patients with uterine fibroids who wished to conceive, in which 152 patients received HIFU ablation treatment (HIFU group) and 194 patients received LM treatment (LM group). The parents' baseline characters were recorded and the pregnancy outcomes were evaluated in a median follow-up time of 42 months (range: 16 ∼ 81) after the treatment, and the differences of the two groups were compared. RESULTS: Patients with uterine fibroids in HIFU group had a significant shorter pregnancy interval than that in LM group (10 months VS. 13 months, p < .05). No significant differences were observed in pregnancy rate, miscarriage rate, live birth rate, natural pregnancy rate, cesarean section rate, and perinatal complications rate between the HIFU group and the LM group (p > .05). When stratified by age, infertility history, fibroid types, fibroid numbers, and fibroid sizes, there was no statistically significant difference in pregnancy rate between the HIFU group and the LM group (p > .05). CONCLUSIONS: Based on the results from this study, both HIFU and LM can be safely used to treat patients who wish to conceive. The pregnancy outcomes of post-HIFU are similar to that of post-LM.

PLGA nanoparticles delivering CPT-11 combined with focused ultrasound inhibit platinum resistant ovarian cancer.

BACKGROUND: Ovarian cancer cells show resistance to platinum drugs treatment, which brings a big challenge to clinical therapeutics. This study aimed to construct effective drug delivering nanoparticles specifically targeting ovarian cancer cell. METHODS: Poly lactic-co-glycolic acid (PLGA) were used to form Nano-spheres by double emulsion method, and to deliver CPT-11. Connected with targeted LHRH-a molecules, their effects were tested by ovarian cancer cell A2780/DDP in vitro and in vivo. RESULTS: We successfully constructed PLGA nanoparticles carrying LHRH-a (Luteinizing hormone releasing hormone analogue) and CPT-11 (irinotecan HCl trihydrate), which can specifically target LHRH receptor high expression ovarian cancer cell A2780/DDP (cisplatin). Combined with focused ultrasound in vitro, LHRH-a/CPT-11/PLGA nanoparticles significantly inhibited the proliferation of A2780/DDP cells (a cisplatin-resistant A2780 cell line), and the cells were obviously arrested at S phase. Both the mRNA expression and protein level of Caspase3 increased, while Bcl-2 and MMP2 declined, which promoted apoptosis. In vivo, LHRH-a/CPT-11/PLGA nanoparticles bind specifically with LHRH receptor on xenograft tumors of A2780/DDP. With focused ultrasound, LHRH-a/CPT-11/PLGA nanoparticles inhibited the growth of A2780/DDP xenograft tumors significantly. The expression level of VEGF, Bcl-2 and MMP2 reduced, while Caspase3 increased in tumors. CONCLUSIONS: CPT-11 delivering PLGA nanoparticles with LHRH-a specifically target ovarian cancer cell A2780/DDP, and work locally when combined with focused ultrasound. They increase local drug concentration and reduce side effects. This research may provide a new effective therapeutic strategy for recurrent platinum resistant ovarian cancer.

Knockdown of ALPK2 inhibits the development and progression of Ovarian Cancer.

BACKGROUND: Alpha protein kinase 2 (ALPK2) was known to play a vital role in cancer by regulating cell cycle and DNA repair. Ovarian cancer (OC) is one of the most lethal malignancies in the female reproductive system. The emphasis of this study is to explore the role of ALPK2 in OC. METHODS: Firstly, tumor and normal tissues were collected for detecting expression of ALPK2 in OC. Lentivirus-mediated shRNA knockdown of ALPK2 was used to construct OC cell model, which was verified by qRT-PCR and Western blot. The cell proliferation was detected by MTT, cell cycle and apoptosis were measured through flow cytometry. Wound-healing assay was conducted to detect the migration of OC cells. RESULTS: It was proved that the expression of ALPK2 in OC tissues was significantly higher than that in normal ovarian tissues. Moreover, knockdown of ALPK2 could inhibit proliferation, migration and promote apoptosis, arrested cell cycle of OC cells. It was also found that ALPK2 knockdown inhibited tumor growth in xenograft mice in vivo. Furthermore, ALPK2 was involved in OC cells via regulating EMT-related proteins (N-cadherin, Vimentin and Snail), inhibiting apoptosis-related proteins (Bcl-2, Bcl-w, HSP27, HSP60, IGF-I, IGF-1sR, Survivin and XIAP), as well as the regulation of downstream pathways (Akt, p-Akt, Cyclin D1, CDK6 and PIK3CA). CONCLUSIONS: In conclusion, ALPK2 might serve as an optional target for prognosis and therapeutic of OC patients.

Expression of Sfrp5/Wnt5a in human epicardial adipose tissue and their relationship with coronary artery disease.

Secreted frizzled-related protein 5 (Sfrp5) primarily acts in combination with wingless-type family member 5a (Wnt5a), to inhibits chronic inflammation and repress atherosclerosis and other metabolic disorders. Epicardial adipose tissue (EAT), surrounding the heart and coronary arteries, has been found to be highly related to the progression of coronary artery disease through adipokines production. However, little is known about EAT-derived Sfrp5 and Wnt5a in humans. We aimed to investigate whether the EAT-derived Sfrp5/Wnt5a levels are altered in patients with CAD. Fifty-eight patients with CAD and 29 patients without CAD who underwent cardiac surgery were enrolled. Serum samples and paired adipose biopsies from EAT and subcutaneous adipose tissue (SAT) were collected, and Sfrp5 and Wnt5a levels were detected. Correlation and multivariate regression analyses were performed to determine the relationship between Sfrp5/Wnt5a expression and CAD and other clinical risk factors. According to the results, the CAD group had lower Sfrp5 and higher Wnt5a levels in EAT and serum (all p < 0.05). Serum Sfrp5 levels were significantly lower in CAD patients with impaired myocardial function. EAT Sfrp5 mRNA levels and serum Sfrp5 levels were both negatively associated with the presence of CAD, after adjustment for known biomarkers, EAT mRNA and serum Wnt5a levels correlated positively with the presence of CAD. Thus, we concluded that low Sfrp5 and high Wnt5a levels are associated with the presence of CAD, independent of other conventional risk factors.

Study on the Significance of Folate Receptor-Mediated Staining Solution (FRD) Staining in Screening High Grade Cervical Lesions.

BACKGROUND The aim of this study was to investigate the significance of folate receptor-mediated staining solution (FRD) in examination of cervical lesions during gynecological examination. MATERIAL AND METHODS A total of 404 patients participated in this study. FRD staining was applied to screen high grade cervical lesions. ThinPrep cytology test (TCT) and human papillomavirus (HPV) testing were also used for screening high grade cervical lesions. Coincidence rate and KAPPA value of different methods were compared by SPSS software. RESULTS As for CIN2+ and CIN3+, sensitivities for HPV testing were (96.92% and 97.78%) >TCT classification 1 (90.77% and 91.11%) >FRD staining (80.00% and 86.67%) >TCT classification 2 (70.77% and 77.78%), respectively. While specificities for HPV testing were (7.08% and 6.44%)

Analysis of the Reproductive Outcome of Patients with Cesarean Scar Pregnancy Treated by High-Intensity Focused Ultrasound and Uterine Artery Embolization: A Retrospective Cohort Study.

STUDY OBJECTIVE: To investigate risk factors for infertility and recurrent cesarean scar pregnancy (CSP) after previous CSP. DESIGN: A retrospective cohort study (Canadian Task Force classification II-1). SETTING: University hospital. PATIENTS: Between January 2007 and April 2016, a total of 650 patients were included, all diagnosed with CSP and treated by high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE), followed by suction curettage under hysteroscopic guidance. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Follow-up of the reproductive outcomes ended in June 2017. A total of 135 of the 650 patients with CSP were involved in the study, among whom 32 became infertile, 78 had an intrauterine pregnancy, and 25 had recurrent CSP after previous CSP. Age (≥35 years; odds ratio [OR], 4.252; p = .002), ß-human chorionic gonadotropin (≤5000 mIU/mL; OR, 3.778; p = .011), and longer duration of amenorrhea (>56 days; OR, 2.507; p = .05) were risk factors for infertility. Treatment with UAE (OR, 5.796; p = .003), more abortions (≥4; OR, 2.851; p = .022), and being asymptomatic (OR, 4.175; p = .039) were risk factors for recurrent CSP. There was no statistically significant difference in the subsequent outcomes of pregnant women in the HIFU and UAE groups (p >.05). CONCLUSION: More attention should be given to subsequent reproductive outcomes after CSP, not only for intrauterine pregnancy, but also for infertility and recurrent CSP. Early diagnosis and treatment of CSP could reduce the risk of infertility and recurrent CSP. HIFU seemed to be superior to UAE in reducing the risk of recurrent CSP. Patients with CSP should adhere to strict contraception if they do not desire more children.

Effects of T2 Heat Treatment on Microstructure and Properties of the Selective Laser Melted Aluminum Alloy Samples.

In this paper, aluminum alloy samples were fabricated by selective laser melting (SLM) and subsequently T2 heat treatment was undertaken. In order to obtain comprehensive results, various experiments on densification, hardness, tensile strength, bending strength and microstructure characterization were carried out. The results show that densification of samples after T2 heat treatment does not vary very much from the SLMed ones, while the Brinell hardness and strength decreases to about 50%. Moreover, the plasticity and fracture deflection increases about 3 fold. The effects on the microstructure and the mechanical properties of the SLMed aluminum alloy samples and subsequent T2 heat treatment were studied.

A comparison of high-intensity focused ultrasound and uterine artery embolisation for the management of caesarean scar pregnancy.

PURPOSE: The aim of this study was to retrospectively analyse the clinical data of 122 patients with caesarean scar pregnancy (CSP) treated in our hospital, to compare the outcomes between high-intensity focused ultrasound (HIFU) and uterine artery embolisation (UAE). MATERIALS AND METHODS: Among the 122 patients, 76 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, 46 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Pain score, intraoperative blood loss in suction curettage under hysteroscopy guidance, time for vaginal bleeding, ß-human chorionic gonadotropin (ß-hCG) to return to normal level, normal menstruation recovery, hospital stay, and the adverse effects were all compared. RESULTS: No statistically significant differences between the two groups in the intraoperative blood loss, hospital stay, time for ß-human chorionic gonadotropin (ß-hCG) to return to normal level, or time for normal menstruation recovery were observed. The pain score was lower and the adverse effects were fewer in the HIFU group than those in the UAE group. However, the time for vaginal bleeding was longer in the patients treated with HIFU than that of patients treated with UAE. CONCLUSIONS: Based on our results, it appears that either HIFU or UAE combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP. Compared with UAE, HIFU treatment for CSP has the advantages of a lower pain score and fewer adverse effects.

High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy.

The aim of this study was to retrospectively evaluate the safety and feasibility of high-intensity focused ultrasound (HIFU) treatment combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy (CSP).Fifty-three patients with definite CSP were treated with HIFU followed by suction curettage under hysteroscopic guidance. All the patients received 1 session of HIFU ablation under conscious sedation. Suction curettage under hysteroscopic guidance was performed at an average of 2.9 (range: 1-5) days after HIFU ablation. Blood flow of pregnancy tissue before and after HIFU, intraoperative blood loss in suction curettage and hysteroscopy procedure, time for ß-human chorionic gonadotropin (ß-hCG) to return to normal level, and time for normal menstruation recovery were recorded.Immediately after HIFU treatment, color Doppler ultrasound showed that the fetal cardiac activity disappeared and the blood flow in the pregnancy tissue significantly decreased. All the patients underwent suction curettage under hysteroscopic guidance after the treatment of HIFU, the median volume of blood loss in the procedure was 20 mL (range: 10-400 mL). The average time for menstruation recovery was 35.1 ±â€Š8.1 (range: 19-60) days. The average time needed for serum ß-hCG to return to normal levels was 27.5 ±â€Š6.4 (range: 12-40) days. The average hospital stay was 7.8 ±â€Š1.5 (range: 5-11) days.Based on our results, it appears that HIFU combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP at gestational ages <8 weeks.

Hysteroscopic management of congenital external cervical os stenosis using a "no-touch" technique in an adolescent.

BACKGROUND: Congenital external cervical os stenosis, one type of congenital cervical atresia, is particularly rare, and no case has been documented so far. CASE: A 12-year-old virginal patient with a history of mild vaginal bleeding for 14 days and lower abdominal pain for 10 days during her menarche was diagnosed with congenital external cervical os stenosis. Using a "no touch" technique, the diagnosis was further confirmed through a diagnostic hysteroscopy, and the narrow external cervical os was successfully corrected by resectoscopy, leaving the hymen intact. The patient was free of any symptoms postoperatively. RESULTS AND CONCLUSION: We discuss the above-mentioned case and data already published in the literature. Congenital external cervical os stenosis in non-sexually active patients can be managed by diagnostic and operative hysteroscopy using a "no touch" technique while keeping the hymen intact.

Efficacy of estrogen therapy in patients with intrauterine adhesions: systematic review.

Hysteroscopic adhesiolysis has become the preferred option for management of intrauterine adhesions (IUA). Use of estrogen as perioperative adjuvant therapy has been suggested for preventing recurrent adhesions. The primary objective of this article was to review the literature for evidence of the efficacy of estrogen therapy in the management of IUA. All eligible studies were identified using computerized databases (PubMed, Scopus. and Web of Science) from their earliest publication date to July 2013. Additional relevant articles were identified from citations in these publications. Twenty-six studies were identified that reported use of hormone therapy as ancillary treatment after adhesiolysis. Of these studies, 19 used at least one of the following methods: intrauterine device, Foley catheter, hyaluronic acid gel, or amnion graft, in addition to hormone therapy as ancillary treatment. In 7 studies, hormone therapy was used as a single ancillary treatment. In 2 studies, no adjunctive therapy was used after adhesiolysis. Meta-analysis could not be performed because of the differences in treatment methods in these articles. There was a wide range of reported menstrual and fertility outcomes. Better menstrual and fertility outcomes were associated with use of estrogen in combination with other methods of ancillary treatment. At present, hormone therapy, in particular estrogen therapy, is beneficial in patients with IUA, regardless of stage of adhesions. However, estrogen therapy needs to be combined with ancillary treatment to obtain maximal outcomes, in particular in patients with moderate to severe IUA.