Diagnostic Performances of Tridimensional Rectosonography and Magnetic Resonance Imaging in Rectosigmoid Endometriosis: A Prospective Cohort Study on 101 Patients.

Tridimensional rectosonography (3-D RSG) is a transvaginal ultrasonography procedure combining intrarectal contrast with tridimensional technology. The objectives of this study were to assess the diagnostic performances of 3-D RSG in deep infiltrating rectosigmoid endometriosis using surgery and pathology as the gold standard, and to compare its results with those of magnetic resonance imaging (MRI). Patients referred for endometriosis with symptoms suggesting deep infiltrating intestinal endometriosis (DIE) were included if they agreed to undergo a 3-D RSG and MRI and if there was a surgical indication related to endometriosis. The study was a non-randomized monocentric prospective cohort study (Canadian task force classification Level II-2). From May 2012 to May 2017, 101 patients were included. Sixty patients (59.4%) had bowel involvement of the rectum (n = 21, 20.8%) or of the sigmoid (n = 39, 38.6%) confirmed in surgery and/or in pathologic testing. In the diagnosis of rectosigmoid DIE, 3-D RSG sensitivity, specificity, positive predictive value, negative predictive value, accuracy and κ index were 93%, 95%, 97%, 91%, 94% and 0.88, respectively. For MRI they were 87%, 90%, 93%, 82%, 88% and 0.76, respectively. The accuracy was not significantly different between 3-D RSG and MRI (p = 0.181). In conclusion, 3-D RSG is an effective technique to diagnose rectosigmoid endometriosis and seems to have similar diagnostic performances to MRI for this indication.

Correlation between three-dimensional rectosonography and magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: a preliminary study on the first fifty cases.

OBJECTIVES: Deep infiltrating endometriosis (DIE) raises a number of diagnostic and therapeutic problems. Magnetic resonance imaging (MRI), the reference technique in endometriosis, is questioned for posterior pelvic lesions, especially in rectosigmoid locations. In this study, we describe a new technique called three-dimensional rectosonography (3D-RSG), which combines standard transvaginal ultrasonography (TVUS), 3-dimensional (3D) ultrasonography and the use of water for rectal contrast. We also assess the correlation between 3D-RSG and MRI in the diagnosis of rectosigmoid endometriosis. STUDY DESIGN: This study included 50 consecutive women with symptoms suggestive of DIE. After colorectal enema, they underwent a gynecological examination and a 3D TVUS during which 120ml of water was injected in the rectosigmoid to improve the performance of the examination. All patients also underwent an MRI and surgery was offered to the patient if there was discordance between the two procedures. RESULTS: Fifty women underwent 3D-RSG between May and November 2012. All procedures were well tolerated by patients. Two examinations (4%) were stopped for technical reasons. Nineteen rectosigmoid nodules were diagnosed in 18 women (36%). Eighteen of these nodules were also identified on MRI, and one (2%) nodule seen on MRI was not diagnosed by 3D-RSG. In 31 examinations (62%), neither technique identified an intestinal lesion. There was a concordance rate of 96% between the two techniques. Using MRI as the reference technique, 3D-RSG had a sensitivity of 0.95, a specificity of 0.97, a positive predictive values of 0.95, and a negative predictive value of 0.97. There was a 30.3 positive likelihood ratio and a 0.05 negative likelihood ratio. CONCLUSIONS: 3D-RSG seems an interesting new method for diagnosis of rectosigmoid endometriosis and is both feasible and well tolerated. 3D-RSG is highly concordant with MRI in this indication, although further studies are needed to confirm these primary results.

Three-dimensional ultrasound in the management of bladder endometriosis.

STUDY OBJECTIVE: To assess the performance of three-dimensional (3D) ultrasound with color Doppler in the diagnosis of bladder endometriosis compared with magnetic resonance imaging (MRI) and cystoscopy. DESIGN: Canadian Task Force classification II-3. SETTING: Department of gynecology and obstetrics of a university hospital. PATIENTS: Eight women who reported urinary tract symptoms suggestive of bladder endometriosis between May 2012 and November 2013. INTERVENTIONS: For all cases, we assessed the size of the endometriotic nodule, its location on the bladder wall, and the distance between the lesion and the ureteral meatus, with pelvic 3D ultrasound (full bladder), uro-MRI, and cystoscopy. The results were compared with the postoperative histopathologic findings. MEASUREMENTS AND MAIN RESULTS: The pathology results differed from those produced by imaging by a mean ± SD of -3.5 ± 6.4 mm on transvaginal ultrasound (TVUS) and -5.75 ± 11.9 mm) for MRI. There was no significant difference between imaging and pathology findings (p = .20) or between the 2 imaging findings (TVUS and MRI) (p = .73). Results showed a trend toward better accuracy for 3D ultrasound than MRI with smaller SDs (p = .08). Cystoscopy and ultrasound were compared; however, without any tools to assess the distance in cystoscopy, no statistical result was possible. CONCLUSION: Ultrasound seems to be superior to cystoscopy and is at least as effective as MRI in diagnosing and planning the surgery for bladder endometriosis.

Take a look at the CHIN! --early diagnosis of isolated agnathia using two- and three-dimensional sonography.

Agnathia is a very rare malformation characterized by the absence of the mandible, which occurs either as an isolated malformation or in association with other deformities. We report the first case of an isolated agnathia diagnosed at 12 weeks due to the absence of the chin; the case was diagnosed using two- and three-dimensional ultrasonography and was confirmed by pathological analysis after the pregnancy was medically terminated at 17 weeks. Usually, isolated agnathia is a lethal malformation and its prenatal diagnosis is often delayed beyond the second trimester of pregnancy. We therefore suggest a systematic 'look at the CHIN', i.e. Chin, Headbone outlines (skull and nasal bones), Inner head, Nuchal translucency, using the sagittal view of the cephalic pole at 12 weeks.

[Noise-induced hearing loss: news in the regulation]. / Hypoacousie due au bruit: la réglementation évolue.

Noise-induced hearing losses (NIHL) are among the most often encountered occupational diseases in many industrial countries. This is true in terms of the number of exposed workers and in the amount of health insurance or State health care compensations. These handicaps are not reversible. In order to understand why this is, we will explain how high levels of noise pressure can affect the ear, by describing the three parts of the ear, including some details about the inner ear and its sensitive cells. Several epidemiological surveys indicate that an average of 6.8 %, French employees are exposed to dangerous levels of noise with vast differences according to their sector of activity. The most exposed are found in the wood and paper industries (37.4 %), in large plants and amongst intermittent workers. Males are five times more exposed than females, but they are much more numerous in these industries. About 5 million French people suffer from hearing disorders; 2 million of them are under 55 years of age. The Labour Ministry controls the occupational medicine services where exposed workers are subjected to a special check-up, which includes an audiometric examination at least every two years. But for the others, it is useful to know the danger signs of hearing disorders, like hearing fatigue (TTS), tinnitus or difficulties in understanding with background noise. Aging also affects hearing capabilities: this is called presbyacusis, which can be a confusing factor in the assessment of NIHL in older workers. In order to improve the protection of all workers in the EC, a recent European Directive will decrease the maximum level of tolerated noise (from the current 90 dBA) to 87 dBA before March 2006. In addition, the level at which a preventive programme has to be developed (hearing conservation programme) will start at 80 dBA instead of the current 85. The French compensation system for workers suffering from NIHL has also recently been modified. Such a modification will increase the number of compensations (probably by 4 times). The annual cost of the aforementioned compensations was 100 million in 2003.

[Measuring noise]. / Les chiffres du bruit.

High levels of noise encountered both in leisure activities and at workplaces can be somewhat annoying, but they can also cause hearing damage. In order to lessen these risks, some physical characteristics of the sound phenomenon need to be understood. The level of a sound is given in dB, a logarithmic unit in which simple addition is not available : 100 dB + 100 dB = 103 dB. The highest level of noise which can be tolerated by the human ear is considered to be 120 dB. Another component of sound characteristics is the frequency, which describes the height of a sound. The frequency is given in Hz, the human hearing field is comprised in the range of 20 to 20,000 Hz. Regarding the sensitivity of the ear, depending on the frequency, acusticians use a weighed dB, called dB(A), which takes into account a lower risk to hearing below 500 Hz and above 6 kHz. They also integrate the energy measured during a period of time to take the fluctuation of usual noise levels into account. So that currently, the levels of noise are often given in LAeq (equivalent to the level of continuous noise given in dBA). For moderate levels of noise, another weighted filter is used in sound level meters : the C curve, because low frequencies, although they are less dangerous for the ear, are more disturbing. In every day life, we sometimes have noise levels reaching 100 dB, and even 120 dB (fire alarms). Amplified music can reach 110 dBA, but a French regulation limits the output of PCPs (Walkmans) to 100 dB and the levels in concerts and discotheques to 105 dBA. At the workplace, the maximum level of noise allowed by French Law is 90 dBA for an 8 hour exposure, and 140 dB for peaks. In order to improve the protection of all workers in the EC, a recent European Directive will decrease the maximum level to 87 dBA before March 2006.