Efficacy of transvaginal sonography and transvaginal doppler sonography in diagnosis of abnormal endometrial pathology

To evaluate the diagnostic efficacy of a simple non - invasive transvaginal Sonography [TVS] and transvaginal Doppler sonography in the diagnosis of abnormal endometrial pathology compared to the invasive endometrial biopsy. This study was done on 30 patients with abnormal uterine bleeding from Shibin El-Kom teaching hospital, Al-Hussein university hospital and Menofyia university hospital. All of them were in perimenopausal period. The patients underwent TVS for measurement of endometrial thickness and transvaginal Doppler sonography to measure resistance index [RI] and pulsatility index [PI]. Endometrial biopsy had done for all patients and the results were compared. Endometrial thickness exceeding 6 mm was plotted as a cut-off level for suspecting endometrial pathology. At 9.5 mm. thickness the sensitivity and specificity for diagnosis of endometrial carcinoma were 100% and 87% respectively. On the other hand the RI of 0.79 carries 100% sensitivity and 91% specificity for diagnosis of endometrial carcinoma, and the PI of 2.1 gives 92% sensitivity and 96% specificity for diagnosis of endometrial carcinoma. Combination of trans-vaginal sonography and Doppler transvaginal sonography posses a high sensitivity and specificity that makes them a clinically useful and applicable single test in prediction of endometrial malignancy in cases of abnormal uterine bleeding

Randomized, comparative study of clinical and metabolic parameters among continuous, extended, and cyclic combined oral contraceptive pill users

This open, prospective, randomized, comparative study evaluated clinical, metabolic, and histopathological aspects of cyclic, extended, and continuous use of a COC containing 30 micro g EE and 75 micro g gestodene [Gynera] in 245 women for 18 cycles. Continuous [82 women] and extended [80 women] pill users had significantly fewer bleeding days requiring sanitary protection than cyclic users [83 women]. Spotting increased initially in continuous and extended pill users but declined after the 4[th] cycle. Amenorrhea rates increased significantly after the 4[th] cycle reaching 85% and 71.4% in the last cycle in continuous and extended pill users, respectively. No significant changes in BP or weight as well as a significant increase in hemoglobin concentration were observed in all study groups. No significant changes in lipid profile were observed except a significant increase in HDL-cholesterol in the continuous group. Insulin levels increased significantly with no associated change in glucose levels in all study arms. A significant increase in both fibrinogen and PAI-1 and a significant reduction in PT without changes in other coagulation parameters were observed in all study arms. Continuous and extended COC pill use for 18 cycles was well tolerated with satisfactory clinical effects and good compliance without changes in BP or weight. The treatment was associated with high rates of amenorrhea after the 4[th] cycle, less severe adverse effects, and metabolic changes similar to those in cyclic users

Systematic pelvic and aortic lymphadenectomy in cervical, endometrial and ovarian malignant tumours: patterns of spread and surgical implications

Pelvic and aortic nodes are common sites of metastasis from gynaecologic malignancies, and there is no question that evaluation of lymph node status provides an important prognostic infomation. The aim of the study was to assess the patterns of lymphatic spread of gynaecologic malignancies, the number of nodes which can be excised from each pelvic and aortic group, and the impact of this surgical procedure on the perioperative complications and survival. Between January 1998 and December 2002, 50 patients with previously untreated and biopsy-proven gynaecologic malignancies: cervix [n=15], ovary [n=17], and endometrium [n=18] Were operated upon in the Departments of General Surgery, and Gynaecology and Obstetrics, Minoufnya University Hospital. The surgical procedure consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy and/or omentectomy, in addition to systematic pelvic and Para-aortic Iymphadenectomy. The median number of nodes removed was 21 pelvic [range 11-38] and 8 aortic [range 5-18]. Positive nodes were found in 22 patients [44%], 12 having pelvic, 4 aortic, and 6 both pelvic and aortic metastasis. The median number of positive nodes was 5 pelvic [range 1-12] and one aortic [range 1-6] nodes. The most frequently involved node groups were the obturator group with both cervical and ovarian carcinomas, and the external iliac group with endometrial carcinoma. The higher prevalence of aortic metastasis was observed in ovarian carcinoma. Lymphocele was the most frequent postoperative complication in 20% of patients. No postoperative mortality occurred in this series. The 5-year survival rate of patients with lymph node metastasis was significantly worse than that of patients without node metastasis [31% versus 84% P=<0.001]. These data may be useful for tailoring lymphadenectomy in relation to the preferred sites of retroperitoneal lymph node metastasis and the median number of nodes resected from each group, and confirms that systematic pelvic and aortic lymphadenectomy is a feasible procedure and can be performed with acceptable morbidity and no mortality. However, to provide solid evidence that this procedure has a therapeutic benefit, randomized controlled studies are needed