Adnexal mass: Pre operative characterization in the emergency department transvaginal color Doppler sonographic early diagnosis and serial assessment: Best predictor

This prospective cohort study aimed at evaluating the value of transvaginal color doppler sonography [TV-CDS] in the early detection and serial assessment of adnexal masses. Serial TV-CDS was performed on 102 women with adnexal masses referred over 18 months. 66 women having adnexal masses with negative pregnancy test were examined at 3, 6, 12 weeks after initial examination [group I]and 36 women hating positive pregnancy test with ectopic pregnancies [EPs] were examined [4-11] weeks [mean 6.3w] postmenstrual [group II]. 83% of high impedance flow masses underwent regression whereas only 22% of lesions with low impedance flow did. 20% of lesions that regressed had a significant drop in pulsatility index [PI] Probability of regression was the greatest in young women [less than 40 years of age] and in masses < 5cm. Changes in PI were more predictive of regression than morphology or patient age. 91% of women received progestational suppression demonstrated regression with decrease of PI and peak systolic velocity [PSV] and the rest of patients completed regression on 6 months follow up treatment. The mean systolic velocity of the EPs seas 35.4 cm/s compared with 28.4 cm/s in corpus luteum cysts [CLCs] with no significant statistical difference [P = 0.1]. The resistive index [RI] of BPs ranged front 0.15 to 1.6 [mean +/- SD. 0.61 +/- 0.24] compared with 0.4 to 0.7 [mean +/- SD. 0.52 +/- 0.10] in CLCs with a significant statistical difference [P = 0.003]. The RI of less than 0.4 had a specificity of 100% and a positive predicative value PPV of 100% for diagnosing EP but was present in only [sensitivity] 15% [confidence interval 7% - 23%] of EPs. A RI of greater than 0.7 had a specificity of 100% and a PPV of 100% for diagnosing EP and was present in only 31% [confidence interval 21% - 41%] of EPs. Serial TV - CDS is a useful non-invasive parameter in early detection of adnexal lesions.starting serious acute abdomen and those lesions which may spontaneously regress avoiding unnecessary surgeries. Changes in PI were predictive of regression [90%] than morphology or patient age. Bath low and high RI discriminate EP from a CLC before management

Transvaginal color doppler ultra-sonography in bleeding patients suspected of having residual trophoblastic tissue

Residual trophoblastic tissue is an infrequent sequel to labor and abortion presenting as late postpartum and postabortion hemorrhage. Because it may be difficult to make an accurate diagnosis on clinical grounds alone, ultrasound is often used as a non invasive diagnostic method. The aim of this study was to evaluate the diagnostic accuracy and clinical usefulness of transvaginal color doppler ultrasonography [TV-CDU] in postpartum and postabortion patients with excessive hemorrhage who are suspected of having residual trophoblast. Forty-six women with excessive hemorrhage referred for possible residual trophoblastic tissue were evaluated by [TV-CDU]. Based on color doppler imaging [GDI], patients were divided prospectively into groups: Women who had an empty uterus with a normal uterine cavity, those with a pure endometrial fluid collection and no echogenic foci of echogenicity, and those with intracavitary heterogeneous material with mixed echo patterns of fluid and solid components. In each group, doppler studies were performed and the resistance index [RI] was calculated. The doppler results were correlated with clinical and pathologic follow-up: Twenty- six subjects had a normal uterine cavity and seven had a pure endometrial fluid collection, all were treated conservatively and none showed later clinical evidence of residual trophoblastic tissue. In thirteen women, residual trophoblast was strongly suggested from the [GDI] of ultrasonography: Five showed an endometrial fluid collection with some echogenic foci, and eight exhibited intracavitary mixed echogenic material. All underwent curettage, and residual trophoblastic tissue was found in ten of the thirteen. The mean [ +/- standard deviation] RI to flow in the myometrial arteries was 0.54 +/- 0.15 in women without residual traphoblast and 0.35 +/- 0.1 in those with residual trophoblastic tissue [P<0.01]. Our experience suggests that [TV-CDU] is an effective noninvasive method for evaluating patients with postpartum and postabortion hemorrhage who are suspected of having residual trophoblastic tissue. Its use enhances the-positive preoperative diagnosis of residual trophoblastic tissue and may reduce unnecessary curettage procedures

Comparative study in management of postmenopausal osteoporosis

Ninety cases from Port Said general and private clinics were included in this study; all were complaining of postmenopausal osteoporotic problems, mainly back pain. Patients were classified into three groups, every group of thirty women. In the first group, health education for nutrition, diet and exercise were advocated. Calcium intake 1 gm orally daily was experimented in the second group. Hormone replacement therapy in the form of 1.25 mg estrogen [Premarin] was used orally/day for the third group. Data collection was carried out using interviewing questionnaire, patient assessment sheet, laboratory studies, x-ray, visual analogue scale and simple descriptive pain intensity scale. These tools were done at the beginning of study and after six months. The results revealed a highly significant exercise in the treatment of osteoporosis where regular weight bearing exercise has more positive effect on the maintenance of spinal bone density, self perceived health, functional fitness and psychological well-being than participant on calcium and hormone replacement therapy