ABSTRACT
PURPOSE: The purpose of this study was to investigate magnetic resonance imaging (MRI) and 3-dimensional transperineal ultrasound (3D-TPUS) features of pelvic floor dysfunction (PFD) in symptomatic women in correlation with digital palpation and to define cut-offs for hiatal dimensions predictive of muscle dysfunction. METHODS: This prospective study included 73 women with symptoms suggesting PFD. 3D-TPUS, MRI, and digital palpation of the levator ani muscle were performed in all patients. Levator hiatal antero-posterior (LHap) diameter and area (LH area) were measured at rest and at maximum muscle contraction. RESULTS: The reduction in LHap diameter and LH area during contraction was significantly less in women with underactive pelvic floor muscle contraction (UpfmC) than in those who had normal pelvic floor muscle contraction by digital palpation (P<0.001). Statistically significant positive correlations (P<0.001) were found between the Modified Oxford Score and 3D-TPUS and MRI regarding the reduction in the LHap diameter (r=0.80 and r=0.82, respectively) and LH area (r=0.60 and r=0.70, respectively). A reduction in LHap of <6.5% on 3D-TPUS and <7.6% on MRI predicted UpfmC with sensitivities of 46.2% and 82.7%, respectively. A reduction in LH area of <3.4% on 3D-TPUS and <3.8% on MRI predicted UpfmC with sensitivities of 75.0% and 88.5%, respectively. MRI was more sensitive in detecting levator avulsion (63.4%) than 3D-TPUS (27.1%). CONCLUSION: MRI and 3D-TPUS had strong positive correlations with findings on palpation, and at certain cut-offs for hiatal dimensions, they can be used as complementary and objective tools to improve the accuracy of diagnosis and management planning of PFD.
Subject(s)
Female , Humans , Diagnosis , Magnetic Resonance Imaging , Muscle Contraction , Palpation , Pelvic Floor , Prospective Studies , UltrasonographyABSTRACT
Polycystic ovary syndrome [PCOS] is the most common endocrine disease in women of reproductive age, with the incidence reported to be about 4-6% in this age group. Ghrelin and resistin hormones are known to be related with the energy metabolism and insulin resistance, moreover, ghrelin is reported to interact with the reproductive function. The aim of the present study was to determine the levels of ghrelin and resistin in patients with PCOS, we also aimed to find out any possible correlations between their levels and other biochemical and hormonal features of this syndrome. A total number of 40 women were enrolled in this study. They were divided into 2 groups: group I [control group] [n=20], group II [PCOS group] [n=20]. Venous blood samples were collected for estimation of serum ghrelin, resistin, insulin and sex hormones. Serum ghrelin levels were markedly decreased in women with PCOS, moreover, there was a negative correlation between its levels and serum levels of luteinizing hormone [LH], testosterone, 17-OH progesterone, and insulin, in addition to its negative association with measures of insulin resistance. As regards resistin, no significant changes were found in serum levels of resistin in PCOS patients in comparison with that of the controls, furthermore, no significant correlation could be detected between its levels and serum insulin levels or measures of insulin resistance in those patients. However, a significant negative correlation was found between resistin levels and testosterone levels. Finally, no significant correlation between ghrelin and resistin levels could be detected in women with PCOS. In the light of the above results it can be concluded that, this peptide ghrelin is involved in the pathogenesis of PCOS syndrome. Regarding resistin, our data is not in favor of resistin being the factor that leads to insulin resistance in PCOS patients, but it could be a factor can interact with testosterone production in those women, this finding needs to be confirmed with further studies because, to our knowledge there is yet no data pointing out the possible relationship between resistin and sex hormones