The role of three-dimensional volume measurement in diagnosing endometrial cancer in patients with postmenopausal bleeding.

OBJECTIVE: To evaluate the role of three-dimensional transvaginal ultrasound in diagnosing endometrial cancer in patients with history of postmenopausal bleeding and compare its effectiveness with two-dimensional ultrasound. METHODS: Transvaginal ultrasound examinations, diagnostic hysteroscopy with subsequent curettage, and/or hysterectomy were performed in 213 consecutive patients with a history of postmenopausal bleeding. The results of the ultrasonographic examinations were compared with the diagnoses on the basis of histologic examination. In addition to an explorative data analysis, receiver operating characteristic curves were shown and areas under curves were calculated. Minimal endometrial volume (2.7 ml) and minimal endometrial thickness (7 mm) of endometrial carcinoma were defined as optimal cutoff values. RESULTS: In 42 patients, endometrial carcinoma was diagnosed. The mean endometrial volume of patients with endometrial cancer, measured by three-dimensional ultrasound, was 11.78 ml. The sensitivity of the endometrial volume at the optimal cutoff (2.7 ml) was 100.00%, the specificity was 69.00%, the positive predictive value was 44.20%, and the negative predictive value was 100.00%. On two-dimensional ultrasound, the mean endometrial thickness of patients with endometrial cancer was 16.6 mm. The sensitivity endometrial thickness measurements at the optimal cutoff (7 mm) was 100.00%, the specificity was 43.3%, the positive predictive value was 30.2%, and the negative predictive value was 100.00%. The area under curve of volume measured by three-dimensional ultrasound was 0.89 (95% CI 0.85-0.93). The area under curve of endometrial thickness was 0.85 (95% CI 0.80-0.91). The comparison of the area under curve of receiver operating curves between endometrial volume and endometrial thickness revealed a significant difference (p=0.023). CONCLUSION: Volume measurement by three-dimensional transvaginal ultrasound has a higher specificity, which means that it has the ability to better identify the negative cases compared to conventional ultrasound. Three-dimensional transvaginal ultrasound is a helpful tool for diagnosing endometrial cancer in patients with postmenopausal bleeding.

Successful birth after laser assisted immobilization of spermatozoa before intracytoplasmic injection.

OBJECTIVE: To describe the first ICSI pregnancy achieved with sperm that were immobilized by using a noncontact diode laser. DESIGN: Case report. SETTING: Fertility center. PATIENT(S): A 36-year-old woman who had had primary infertility for 9 years. INTERVENTION(S): Sperm immobilization by using a 1.48-microm wavelength diode laser and subsequent ICSI. MAIN OUTCOME MEASURE(S): Fertilization and cleavage rates and pregnancy. RESULT(S): Transfer of two embryos with minor fragmentation led to a single pregnancy. The patient delivered a healthy baby in week 38 of gestation. CONCLUSION(S): Use of a noncontact diode laser for sperm immobilization may be a useful alternative to the conventional mechanical approach.

Accuracy of three-dimensional transvaginal ultrasound in uterus volume measurements; comparison with two-dimensional ultrasound.

The purpose of this study was to document the accuracy of 3-D uterus volume and to compare it with 2-D measurements. Transvaginal ultrasound (US) examinations were performed in 48 consecutive patients before hysterectomy. The examinations were stored digitally on an internal disk drive for subsequent measurements in virtual organ computer-aided analysis (VOCAL) program. Immediately after the hysterectomy, the true volume was measured in a water bath. A total of 5 patients were excluded due to difficulty of identifying the borders of their uterus; 8 patients were excluded because of too large fibroids or diffuse hypertrophic enlargement of uterus (volume > 220 mL). Although the volumes estimated by the 3-D method were not significantly different (p = 0.126 first measurement, p = 0.561 second measurement), the volumes estimated by the 2-D method were significantly different (p = 0.005 first measurement, p = 0.012 second measurement). The mean error rates of the two 3-D volume measurements by the same observer were 7.4% and 7.9%, and they were 22.2% and 21.0% for the 2-D volume measurements. It may be concluded that the volume of the uterus can be measured more accurately by 3-D US than by 2-D US.

Three-dimensional ultrasound as a predictor of pregnancy in patients undergoing ART.

Different ultrasound parameters have been used to assess endometrial receptivity during ART treatment, including endometrial thickness, endometrial pattern, endometrial volume, Doppler of uterine arteries and endometrial blood flow. However, conflicting results have been reported with regard to their role in the prediction of pregnancy in ART treatment. The 3D ultrasound with power Doppler provides a unique tool with which to examine the blood supply of the whole endometrium and subendometrial region. Volume assessment can also be precisely performed by 3D ultrasound. Based on a med-line research and on our experience, the clinical use of 3D ultrasound is discussed in this review article.

Ectopic pregnancies with unusual location and an angular pregnancy: Report of eight cases.

OBJECTIVE: The increased use of assisted reproduction techniques has been accompanied by an increase in ectopic pregnancies with unusual location being associated with significant maternal morbidity and mortality. This article reports on seven cases of ectopic pregnancies with unusual location and an angular pregnancy. Diagnostic and therapeutic strategies are discussed and a brief review of literature is presented. STUDY DESIGN: Case series of seven cases with ectopic pregnancy in unusual location, following assisted reproductive technique or conceived spontaneously (cesarean scar pregnancy and early abdominal pregnancy in mesoappendix) and an angular pregnancy, having presented at our hospital during the last eight years. Retrospective analyses. RESULTS: Interstitial pregnancy, cornual pregnancy, cesarean scar pregnancy, early abdominal pregnancy in omentum majus, heterotopic (cervical) pregnancy, early abdominal pregnancy in mesoappendix, angular pregnancy. All patients were surgically treated. CONCLUSION: Diagnosis of ectopic pregnancy with unusual location may be difficult, and differentiation of intact intrauterine or extrauterine pregnancy with adequate consideration of the area of uterine ostium of the fallopian tube may be delicate. Moreover, varying treatment strategies and high rates of complications aggravate the situation.

Simple trachelectomy of early invasive cervix carcinoma in the second trimester.

Although cervical carcinoma is among the most frequently encountered malignancies during pregnancy only a small number of cases during pregnancy have been reported. Usually, the patients have been treated by radical trachelectomy with or without chemotherapy during the pregnancy. Laparoscopic pelvic lymph node dissection with frozen section, simple trachelectomy and cerclage were performed in the 22(nd) week of pregnancy. The histologic examination confirmed a squamous cell carcinoma of the cervix of 35mm diameter, lymphangioinvasion (L1), low grade, clear surgical margin, negative pelvic lymph nodes according to stage Figo IB. Adjuvant chemotherapy with three cycles of cisplatin was performed after surgery. Delivery was performed by cesarean section followed by radical hysterectomy in the the 32(nd) week of pregnancy. Recurrent adjuvant chemotherapy with three cycles of cisplatin and local vaginal iridium radiation were performed after surgery. Patient had no surgery related complications. No relapse of cancer has been diagnosed during the following 16 months. Simple trachelectomy may be alternative treatment option to radical trachelectomy for pregnant women with early stage cervical cancer without lymph node metastasis.

Three-dimensional ultrasound to assess the response to treatment in gynecological malignancies.

OBJECTIVE: To report the potential role of 3D ultrasound to assess the response to treatment in gynecological malignancies. METHODS: The volumes and three 3D power Doppler indices are measured in one case of cervix carcinoma and in one case of ovarian carcinoma with primary radio- and/or chemotherapy before and after treatment. RESULTS: After treatment, tumor volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were reduced in both two cases. CONCLUSION: 3D ultrasound may provide a new method to assess the response to treatment in gynecological malignancies.

The potential of preoperative beta-hCG and progesterone levels to predict failure of laparoscopic linear salpingostomy in ectopic pregnancies.

STUDY OBJECTIVE: To estimate the association between preoperative beta-human chorionic gonadotropin (hCG) and progesterone levels, and success of linear salpingostomy in treatment of tubal pregnancy. DESIGN: Retrospective case control study (Canadian Task Force classification II-1). SETTING: Women's general hospital. PATIENTS: Three hundred five women undergoing laparoscopic linear salpingostomy for ectopic pregnancy. INTERVENTION: Examination of risk factors for surgical failure of salpingostomy by analyzing corresponding receiver operating curves. MEASUREMENTS AND MAIN RESULTS: In 305 women, intervention was successful in 272 and failed in 33, as assessed by either postoperative hemorrhage (16) or rising beta-hCG values (14); 3 women had both. Of 295 patients in whom beta-hCG was evaluated preoperatively, 149 (50.5%) had values of 1000 mU/ml. or less; 75% had progesterone levels of 10 ng/ml or below. No association was found between preoperative beta-hCG and progesterone levels and the success of linear salpingostomy. CONCLUSION: Preoperative beta-hCG and progesterone levels are of no significance with regard to success of linear salpingostomy for treatment of tubal pregnancy.