Fetal liver volume and umblical venous volume flow in pregnancies complicated by insulin-dependant diabetes mellitus

to determine fatal liver volume and its relation with umbilical venous volume flow and maternal glycosylated haemoglobin 'HBAlC" in pregnancies complicated by diabetes mellitus type I. A cross sectional matched control study. Eighty pregnant women were included in this study divided into 2 groups. The first group included 40 women with pre-gestational IDDM [18-36 weeks]. The second group consisted of 40 women with normal pregnancy[control group]. Fetal liver volume measurements were obtained using three-dimensional ultrasound. Umbilical venous cross sectional area [mm[2]] and time-averaged velocity [mm/s Doppler] were determined for calculation of volume flow [ml/min] and flow per kilogram fetal weight [ml/min kg]. Umbilical artery pulsatility index was determined. Fetal liver volume was significantly higher in diabetic women than normal controls [mean [SD]:46 [34.0] Vs 38.0 [29.0]]. A positive correlation existed between fetal liver volume and maternal HbAlc Fetal abdominal circumference, estimated fetal weight, feto placental weight ratio and liver volume/ estimated fetal weight ratio were all significantly higher in the diabetic women than the normal group. Umbilical venous volume flow [ml/min] and umbilical artery pulsatility index were not significantly different between the two groups, but umbilical venous volume flow per kilogram fetal weight was lower [P<0.05] in the diabetic group [95.0 [25.0] ml/min/kg] compared with normal group [110.0[28.0] ml/min/kg]. Measurement of fetal liver volume by 3-D utrasound may play a role in identifying fetal maerosomia in diabetic pregnancies. Fetal liver volume increase is positively related to maternal HbAlc levels reflecting degree of maternal glycemic control. Fetal liver volume normalized for estimated fetal weight is significantly higher in the fetuses of diabetic women. In the present study, umbilical venous volume flow and umbilical artery pulsatility index are not different between diabetic and normal pregnancies

Uterine hemodynamic study after endometrial thermoablation therapy in dysfunctional uterine bleeding [DUB]

to study the hemodynamic changes in uterine artery blood flow using transvaginal color Doppler ultrasonography after endometrial thermoablation therapy in cases of DUB. Prospective randomized study. Al Zahraa University Hospital-Al Azhar University.-Al Haram Hospital for Research and Treatment. Some private hospitals-Egypt. Patients and Fifty premenopausal patients with DUB without obvious structural or premalignant lesions. All patients were in good health and they were submitted to pelvic ultrasonography, pap smear diagnostic hysteroscopy and endometrial biopsy within 6 months of our management. Those patients were randomly divided into 2 groups: first group included 22 patients who received thermal balloon endometrial ablation therapy. Second group: included 25 patients who had medical treatment "a three-months period of medroxy progesterone acetate "10 mg/day". The uterine thermal balloon ablation therapy [Thermachoice] was carried out on cycle days 3-8. Color Doppler measurements were also carried on cycle days 3-8. Flow waveforms were obtained from the main branch of the uterine arteries at the level of the inner cervical os on both sides. Doppler flow parameters were used for subsequent statistical analysis. The measurements took place before the initiation of treatment, on the first post operative day "thermal ablation group only" and 3, 6 months and one year after initiation of the study. Endometrial thermoablation was effective in the treatment of DUB. 20/22 women [90.9%] had amenorrhea, only 2 patients "9.1%" underwent hysterectomy during the follow up period because of problems related to pelvic heaviness recurrent uterine spotting or offensive discharge. The pulsatility index "PI" was significantly higher after endometrial ablation than pretreatment level. The PI was gradually increased throughout the period of follow up [2.8 +/- 0.9 and 2.9 +/- 0.8] at 6 and 12 months post-treatment VS [2.1 +/- 0.5] pretreatment. The hysterectomy rate was significantly higher in the medical therapy group than in thermoablation group "35.7% VS 9.1"-No statistically significant change in uterine artery PI took place after medical therapy. Thermal balloon endometrial ablation therapy induces a gradual rise in uterine artery blood flow impedance which was statistically significant at 6 and 12 months. This rise in impedance may be due to fibrosis in the uterine cavity induced by thermal balloon therapy. The uterine cavity fibrosis is a good marker for therapy success. Thermoablation technique was accepted by the patients with a high efficacy rate "90.9%"

Reliability of MRI versus CT in the evaluation of urinary bladder cancer

Purpose: This study was preformed to evaluate the role of MRI in staging of bladder cancer comparing the results with that of CT and pathological findings

Patients and Methods: Between September 2001 and December 2003, thirty cases with muscle invasive bladder cancer [28 males and 2 females] were studied. Their ages ranged between 27 and 72 years [mean 56.8] years. All patients were subjected to full history taking, complete clinical examination, routine laboratory investigations, urine cytology, abdominopelvic ultrasonography, CT, MRI and cystoscopy with biopsy. Clinically, 22 out of the 30 patients had palpable bladder mass. Twenty out of the 30 cases underwent radical cystectomy, pelvic lymphadenectomy and urinary diversion. The remaining cases were inoperable. The results of MRI and CT staging were compared with those of histopathological examinations

Results: Pathologically, there were transitional cell carcinomas in 18 cases [60%], squamous cell carcinomas in 11 cases [36.6%] and adenocarcinoma in I case [3.3%]. The tumour was involving the anterior wall in 4 cases, the posterior wall in 7 cases, the right lateral wall in 6 cases, the left lateral wall in 7 cases, the dome in 4 cases and the bladder neck in 2 cases. The accuracy of CT in determination of tumour site was 80%. MRI was better than CT in determination of tumour site with an accuracy of 100%. The pathological stage at diagnosis was pT[2], pT[3] and pT[4] in 13 patients [43.3%], 7 patients [23.3%] and 10 patients [33.4%] respectively. CT showed staging accuracy of 63.3% of tumours, under staged in 6.7% and over staged in 30% of patients. MRI was accurate in staging of 90% of bladder cancers, over staged in 10% of patients and under staged in 0%. The accuracy of CT in detection of pelvic lymphadenopathy was 80%, while the accuracy of MRI was 95%

Conclusion: MRI is better than CT for the evaluation of urinary bladder cancers