Ecografía 3D/4D en ginecología: técnica y metodología / Three- and four-dimensional ultrasonography in gynecology: technique and methodology

La gran aportación de la ecografía tridimensional respecto a la ecografía convencional (bidimensional) es el plano coronal. Hasta ahora mediante la ecografía convencional se disponía del corte longitudinal y del corte transversal. La aportación de este tercer plano coronal es lo que permite hacer una reconstrucción volumétrica de los órganos estudiados. La ecografía 3D/4D permite establecer una metodología de adquisición de la región que se quiere estudiar. Estos datos adquiridos se pueden almacenar y/o enviar y transferir mediante sistema DICOM (digital imaging and communication in medicine) lo que permite reconstruir y analizar los volúmenes adquiridos tantas veces como sea necesario, por cuantos observadores se quiera y en cualquier lugar geográfico. En consecuencia, la ecografía en esta modalidad deja de ser una técnica dependiente del operador, siempre y cuando el proceso de adquisición se haya realizado con los parámetros debidamente protocolizados. El objetivo de este artículo es explicar una visión de conjunto de la metodología en 3D y 4D, empezando con la adquisición de imágenes en 3D, con el análisis de planos escaneados, técnicas especiales tales como el VOCAL™ y consejos para optimizar el sistema

The main advantage of three- and four -dimensional ultrasonography (3D/4D US) over conventional, 2-dimensional US is the addition of the coronal plane. Until now, longitudinal and sagittal views were available with conventional ultrasonography. The third coronal plane allows 3D reconstructions of the target organ. 3D/4D US allows us to introduce a methodology for data acquisition, storage and/or transmission to other stations through the Digital Imaging and Communication in Medicine (DICOM) system. Digitally saved volumes of patient data can be readily transferred as often as necessary and can be interpreted by any number of observers in any geographical location. With these capabilities, US ceases to be an operator-dependent technology (requiring only uniformity of acquisition parameters). In the present article, we aim to provide an overview of the methodology of 3D/4D US, ranging from the acquisition of 3D images, analysis of the various scanning options and special tools such as VOCALTM to suggestions on how to optimize the system

Método Essure: contracepción definitiva por vía histeroscópica / The Essure method: a hysteroscopic method for permanent contraception

Objetivo: Describir el procedimiento Essure de contracepción por vía histeroscópica y compararlo con los ya existentes en el armamentario actual de contracepción definitiva. Sujetos y método: Se han analizado tanto los estudios multicéntricos previos a su aprobación como la experiencia referida en trabajos posteriores de grupos expertos en histeroscopia. Resultados: Los resultados de dos estudios multicéntricos internacionales, prospectivos y aleatorizados publicados en 2003 demuestran que el método Essure presenta una elevada eficacia en la prevención del embarazo, superior al 99% con tasas de complicaciones menores inferiores al 3%. Conclusiones: La contracepción definitiva mediante el método Essure, apoyada en una curva de aprendizaje y en una adecuada experiencia en histeroscopia permiten convertirlo en una técnica factible en régimen de consulta y exitosa en el 95% de los casos

Aim: To describe hysteroscopic permanent contraception through the Essure procedure and to compare this procedure with other already available methods. Subjects and methods: We analyzed multicenter studies published before approval of the Essure method as well as the experience reported in subsequent studies by groups with expertise in hysteroscopy. Results: Data from two multicenter, international, prospective, randomized studies published in 2003 demonstrate that the Essure procedure provides high contraceptive efficacy (greater than 99%), with a minor complications rate of less than 3%. Conclusions: Permanent contraception with the Essure procedure, when performed after an adequate learning curve and by practitioners with extensive experience in diagnostic hysteroscopy, can be carried out as an outpatient technique with a 95% success rate

¿Estamos haciendo lo que debemos hacer? / Are we doing everything that we should be doing?

No disponible

Essure: a new device for hysteroscopic tubal sterilization in an outpatient setting.

OBJECTIVE: To evaluate the results of hysteroscopic placement of an intratubal device for permanent birth control in 85 women in an outpatient setting. DESIGN: Prospective, observational study. SETTING: Private university hospital. PATIENT(S): Eighty-five premenopausal women who asked for tubal sterilization by hysteroscopy between July 2002 and July 2003. INTERVENTION(S): Hysteroscopic placement of titanium-dacron intratubal devices in an outpatient setting. MAIN OUTCOME MEASURE(S): Procedure feasibility without anesthesia, success rate of device implantation, patient satisfaction, and confirmation of correct placement. RESULT(S): Successful placement was achieved in 81 patients (95%). Mean time elapsed between the start of hysteroscopy, placement of devices, and removal of optics was 9 minutes (range, 1-35 minutes). No intraoperative or postoperative complications were detected. Of 81 patients, 75 (93%) had abdominal x-ray performed at the third month; bilateral correct placement was confirmed in all of them. CONCLUSION(S): Essure is a safe, effective, and minimally aggressive procedure with satisfactory patient acceptance that does not require anesthesia or hospitalization. It seems to be a good alternative to laparoscopic tubal sterilization.

Angiosarcoma del ovario / Ovarian angiosarcoma

Se presenta el espectro clinicopatológico de un angiosarcoma ovárico en estado avanzado, tratado quirúrgicamente y con quimioterapia adyuvante. La paciente no respondió a la terapia y fallece por diseminación tumoral a los 9 meses

Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings.

PURPOSE: The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. METHODS: The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. RESULTS: The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). CONCLUSIONS: When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected.