Effects of raloxifene combined with low-dose conjugated estrogen on the endometrium in menopausal women at high risk for breast cancer

OBJECTIVES: To compare the effects of low-dose conjugated estrogen (CE), raloxifene, and the combination thereof on the endometrium of postmenopausal women. METHODS: Postmenopausal women between 45 and 60 years of age, with Gail score≥1.67 and no endometrial disorders, were randomly assigned to receive low-dose CE (0.3 mg), raloxifene (60 mg), or combined therapy for 1 year. Transvaginal ultrasound was performed at baseline and every 3 months; the Kupperman Index was assessed at baseline and every 6 months. Endometrial biopsies were performed if endometrial thickness (ET) was ≥5 mm or if vaginal bleeding occurred. The primary outcome was the occurrence of ET≥5 mm over the one-year period. RESULTS: Seventy-three women were randomly assigned and analyzed on an intent-to-treat basis. Eight, three, and four women in the CE, raloxifene, and combination groups, respectively, exhibited ET≥5 mm. No genital bleeding was reported in the combination group. Endometrial biopsy revealed atrophy or polyps in all groups, with one patient in the CE group exhibiting a proliferative endometrium without atypia. At 6 months, there was a progressive increase in mean ET in the CE group, but not in the other two groups, with statistically significant differences at 6, 9, and 12 months. Mean scores for vasomotor symptoms and Kupperman Index favored the CE and combination groups over raloxifene. CONCLUSION: Combined raloxifene and low-dose CE decreased the severity of menopausal symptoms to a similar extent as CE alone and had similar effects as raloxifene alone on the endometrium.

Junctional zone in infertile women: a three-dimensional ultrasound study / Zona juncional em mulheres inférteis: estudo por ecografia tridimensional

Abstract Objective To analyze the interobserver and intraobserver reproducibility of the visualization and continuity of the juncional zone (JZ) by three-dimensional (3D) ultrasound in infertile women, and to evaluate the sociodemographic, hormonal, and structural factors that influence these assessments. Methods A prospective study conducted at the Assisted Reproductive Technology Unit of Hospital Senhora da Oliveira, in the city of Guimarães, Portugal. Transvaginal 3D ultrasonography was performed, and 2 volumes were generated per case. Two observers who were blinded to each other's work analyzed these volumes, choosing the best coronal section. Four months later, one of the observers performed the same methodology. The JZ visualization was classified as optimal, satisfactory, and unsatisfactory, and the JZ continuity, as continuous and discontinuous. The interobserver and intraobserver agreements were analyzed. The influence of hormonal, structural, and sociodemographic factors on the JZ was evaluated. Results In total, 65 women were included in the present study. The interobserver reproducibility was substantial for JZ visualization and continuity (k = 0.635 and 0.753 respectively), and the intraobserver reproducibility was very good for JZ visualization and continuity (k = 0.884 and 0.816 respectively). Trilaminar endometrial pattern was associated with optimal JZ visualization (p = 0.012). The increase of 1 unit in the level of serum estradiol represents a 9.9% decrease in the odds of unsatisfactory visualization of the JZ (odds ratio [OR] = 0.9; 95% confidence interval [95%CI] = 0.814-0.996; p = 0.042). Endometriosis increases the odds of unsatisfactory visualization by 24 times (OR = 23.7; 95%CI = 1.262-437.057; p = 0.034). The prevalence of discontinuous JZs was of 60%. Myomas and endometriosis were associated with discontinuous JZs (p = 0.034 and 0.016 respectively). Conclusion The assessment of JZ visualization and continuity by 3D ultrasound is reproducible enough to be used in the clinical practice.

Resumo Objetivo Analisar a reprodutibilidade inter e intraobservador da visualização e continuidade da zona juncional (ZJ) por ecografia tridimensional (3D) em mulheres inférteis, e avaliar os fatores sociodemográficos, hormonais e estruturais que afetam essas avaliações. Métodos Um estudo prospectivo conduzido no Centro de Procriação Medicamente Assistida do Hospital Senhora da Oliveira, em Guimarães, Portugal. Foi realizada ecografia transvaginal 3D e gerados 2 volumes por caso. Dois observadores, cegos às avaliações um do outro, analisaram os volumes obtidos e escolheram o melhor corte coronal. Após quatro meses, a mesma análise foi realizada por um dos observadores. A visualização da ZJ foi classificada como ótima, satisfatória e não satisfatória, e a continuidade, como contínua ou descontínua. Foram avaliadas as reprodutibilidades inter e intraobservador. A influência de fatores sociodemográficos, hormonais e estruturais na ZJ foi analisada. Resultados No total, 65 mulheres foram incluídas no presente estudo. A reprodutibilidade interobservador foi substancial para a visualização e continuidade da ZJ (k = 0,635 e 0,753, respetivamente). A reprodutibilidade intraobservador foi muito boa para a visualização e continuidade da ZJ (k = 0,884 e 0,816, respetivamente). Endométrio trilaminar associou-se à visualização ótima da ZJ (p = 0.012). O aumento de 1 unidade no nível de estradiol diminuiu a chance de visualização não satisfatória da ZJ em 9,9% (razão de probabilidades [RP] = 0,9; intervalo de confiança de 95% [CI95%] = 0,814-0,996; p = 0,042). Endometriose aumentou a chance de visualização não satisfatória da ZJ em 24 vezes (RP = 23,7; CI95% = 1,262-437,057; p = 0,034). A prevalência de ZJs descontínuas foi de 60%. Miomas e endometriose associaram-se a ZJs descontínuas (p = 0,034 e 0,016, respetivamente). Conclusão A avaliação da visualização e continuidade da ZJ por ecografia 3D é reprodutível, podendo ser utilizada na prática clínica.

Endometrial tuberculosis: hysteroscopic findings of a clinical case / Tuberculose endometrial: Achados histeroscópicos de um caso clínico

Abstract Endometrial tuberculosis is a rare diagnosis in the postmenopausal period, and it can mimic a carcinoma. The present article describes the case of a 54-year-old female patient with weight loss, abdominal pain, and ascites. An ultrasonography showed endometrial thickening, and a video hysteroscopy revealed a uterine cavity with formations with cotton aspect covering the entire endometrial surface and the tubal ostia. An anatomopathological evaluation diagnosed endometrial tuberculosis. The treatment was with a standardized therapeutic scheme (ethambutol, isoniazid, pyrazinamide and rifampicin), and the patient evolved with clinical improvement and normal uterine cavity at hysteroscopy. Considering the lack of pathognomonic hysteroscopic findings of the disorder, it is important to disclose the images of the case.

Resumo A tuberculose endometrial é um diagnóstico raro na pós-menopausa e podemimetizar um carcinoma. O presente artigo descreve o caso de uma paciente de 54 anos com perda de peso, dor abdominal e ascite. A ultrassonografia mostrou espessamento endometrial, e a histeroscopia por vídeo revelou uma cavidade uterina com formações que apresentavam aspecto de algodão cobrindo toda a superfície endometrial e os óstios tubários. Uma avaliação anatomopatológica diagnosticou tuberculose endometrial. O tratamento foi com esquema terapêutico padronizado (etambutol, isoniazida, pirazinamida e rifampicina), e a paciente evoluiu com melhora clínica e cavidade uterina normal na histeroscopia. Considerando a falta de achados histeroscópicos patognomônicos do distúrbio, é importante divulgar as imagens do caso.

Efecto de la frecuencia de aplicación de estrógenos locales sobre el grosor endometrial en mujeres posmenopáusicas / Effect of local estrogen application frequency on endometrial thickness in postmenopausal women

Resumen Introducción: Los estrógenos conjugados vía vaginal para aliviar la atrofia y sequedad vaginales pueden producir cambios endometriales. Objetivo: Conocer el efecto de la frecuencia de aplicación de estrógenos conjugados vía vaginal en el grosor endometrial en mujeres posmenopáusicas. Método: Se estudiaron 70 mujeres posmenopáusicas con sequedad vaginal que recibieron estrógenos conjugados en crema (0.625 mg/1 g) durante 12 semanas divididas de la siguiente manera según la frecuencia de aplicación: grupo 1, dos veces por semana (n = 35) y grupo 2, tres veces por semana (n = 35). Al inicio y final del tratamiento se determinó el valor estrogénico en la citología vaginal y se realizó ultrasonido endovaginal para medir el grosor endometrial. La comparación entre los grupos se realizó con U de Mann-Whitney y entre los valores pre y postratamiento con prueba de Wilcoxon. Resultados: De 70 mujeres reclutadas solo se estudiaron 38 mujeres, 19 en cada grupo, pareadas por valor estrogénico inicial. No se encontró diferencia entre los grupos, ni antes ni después del tratamiento, en el índice de maduración, valor estrogénico ni grosor endometrial. Conclusión: No hubo diferencias en el grosor endometrial entre las distintas frecuencias de aplicación de estrógenos conjugados en crema.

Abstract Introduction: Conjugated estrogens, when used by the vaginal route for the relief of vaginal dryness and atrophy, can produce endometrial changes. Objective: To know the effect of vaginal conjugated estrogens application frequency on endometrial thickness in postmenopausal women. Method: Seventy postmenopausal women with vaginal dryness who received conjugated estrogen cream (0.625 mg/1 g) for 12 weeks were studied. The women were divided according to application frequency as follows: group 1, twice-weekly (n = 35), and group 2, thrice-weekly (n = 35). At baseline and at end-of-treatment, vaginal cytology was examined to determine the estrogenic value, and an endovaginal ultrasound was performed to measure endometrial thickness. The comparison between groups was carried out with Mann Whitney's U-test, and the comparison between baseline and post-treatment values, with Wilcoxon's test. Results: Of 70 recruited women, only 38 were studied, 19 in each group, paired by baseline estrogenic value. No difference was found between groups, neither at baseline nor after treatment, in the maturation index, estrogenic value or endometrial thickness. Conclusion: There were no differences in endometrial thickness between the conjugate estrogen cream different application frequencies.

Hallazgo de Tumor Maligno/Premaligno Insospechado en Estudios 18 F-FDG PET/TC en Pacientes Oncológicos: Incidental Malignant/Premalignant Tumor Detection in Oncological Patients / 18 f-fdg pet/ct

Objetivo Determinar la frecuencia y el tipo de tumor maligno/premaligno insospechado como hallazgo en estudios 18 F-FDG PET/TC en pacientes oncológicos. Material y Métodos Se revisaron retrospectivamente (de enero de 2014 a marzo de 2017), informes de estudios 18 F-FDG PET/TC de pacientes oncológicos, identificando aquellos pacientes con hallazgo de lesión sospechosa de otro tumor maligno como hallazgo incidental. La información fue obtenida a partir de determinadas "palabras clave" en la base de datos del Centro. Los hallazgos se confirmaron mediante histopatología y/o seguimiento clínico y paraclínico de como mínimo seis meses. Resultados De 4.086 pacientes oncológicos estudiados con 18 F-FDG PET/TC, se encontró lesión sospechosa de otro tumor maligno en 130 (3,2%), de los cuales 72 eran mujeres y 58 hombres, con edad media de 61 años. Los tumores primarios más frecuentes (aquellos que motivaron el pedido del examen PET/CT inicialmente), fueron de mama (n = 27), pulmón (n = 27) y colo-recto (n = 20). Se confirmaron por histopatología 49 (1,2%) nuevos tumores malignos/premalignos y dos lesiones metastásicas. La localización del segundo tumor primario correspondió a: colon (n = 18), pulmón (n = 6), mama (n = 6), linfoma (n = 3), ovario (n = 2), endometrio/cuello uterino (n = 2), tiroides (n = 2) y otros (n = 10). Resultaron 28 hallazgos falsos positivos, 31 pacientes no se estudiaron por progresión lesional y 20 pacientes se perdieron de seguimiento. Discusión La prevalencia de neoplasia primaria maligna múltiple (NPMM) es variable entre 0,7 y 11,7%. En nuestra serie, se encontró lesión sospechosa de segundo tumor en 130 casos (3,2%), de los cuales se confirmaron 49 segundos tumores (1,2%), similar a Conclusiones La tasa de detección de tumor maligno insospechado confirmado histológicamente fue de 1,2%. Todo hallazgo incidental sospechoso de malignidad en 18 F-FDG PET/TC debe ser estudiado, ya que puede corresponder a un segundo tumor maligno no sospechado con posibilidad de tratamiento curativo.

Purpose To determine the frequency and type of unexpected malignant/ premalignant tumor as a finding in 18 F-FDG PET/CT studies in oncological patients. Material and Methods Reports of 18 F-FDG PET/CT studies of oncological patients were reviewed retrospectively (from January 2014 to March 2017), with the finding of suspicious lesion of another malignant tumor. The information was obtained from certain "keywords" in the Center's database. The findings were confirmed by histopathology when possible and with clinical and paraclinical follow-up for at least six months. Results Of 4086 oncological patients, studied with 18 F-FDG PET/CT, a suspicious lesion of another malignant tumor was found in 130 (3.2%), 72 female and 58 male sex, average age 61 years. The most frequent primary tumors were: breast (n = 27), lung (n = 27) and colo-rectum (n = 20). 49 (1.2%) new malignant/premalignant tumors and two metastatic lesions were confirmed by histopathology. The location of the second primary tumor was: colon (n = 18), lung (n = 6), breast (n = 6), lymphoma (n = 3), ovary (n = 2), endometrium/cervix (n = 2), thyroid (n = 2) and others (n = 10). There were 28 false positive findings, 31 patients were not studied for progression and 20 patients were lost to follow-up. Discussion The prevalence of multiple malignant primary neoplasia (MMPN) is variable between 0.7 and 11.7%. In our series, a suspicious second tumor lesion was found in 130 cases (3.2%), of which 49 second tumors (1.2%) were confirmed, similar to that reported by other authors. Conclusions The detection rate of unsuspected malignant tumor was 1.2%, coincident with the literature. Any incidental finding suspicious of malignancy in 18 F-FDG PET/CT should be studied since in most cases it corresponds to early diagnosis with the possibility of curative treatment.

Sangrado y terapia hormonal en la menopausia (THM) / Bleeding during menopause hormone therapy (MHT)

La definición de sangrado ginecológico anormal durante terapia hormonal de la menopausia es aquel sangrado no programado durante el uso de la terapia. Este artículo es un pauteo que describe: 1) cuándo diagnosticar unsangrado anormal, ya que difiere según el tipo de esquema hormonal utilizado; 2) eldiagnóstico diferencial del origen del sangrado anormal; 3) los métodos de evaluación para diagnosticar el origen del sangrado. Se destacan los aspectos principales para el diagnóstico diferencial entre patología orgánica versus disrupción endometrial debida al tratamiento hormonal. Además, se describen los ajustes posibles para resolver el sangrado cuando éste se debe a disrupción del endometrio.

Abnormal bleeding related to menopausal hormone therapy is defined as unscheduled bleeding during the use of the therapy. This article outlines when to diagnose an abnormal bleeding -as this differs according to the type of hormonal scheme used-, the differential diagnosis of the origin of abnormal bleeding, and the methods of evaluation to assess the origin of the bleeding. The main aspects are highlighted on the differentiation of organic pathology versus disruption of the endometrium due to treatment. Also, treatment adjustments to resolve bleeding when it is due to disruption of the endometrium are outlined.

Is postmenopausal endometrial fluid collection alone a risk factor for endometrial cancer?

Objective: To determine the usefulness of single-layer, ultrasonographic measurement of endometrial fluid collection [EFC] volume to predict endometrial pathology in asymptomatic postmenopausal patients

Methods: One hundred fifty asymptomatic postmenopausal women were analysed retrospectively from January 2012 to December 2016. After patients with endometrial hyperplasia/neoplasia were included in Group-I, and those with insufficient tissue, endometrial atrophy, or endometritis were included in Group-II; Groups one and two were compared with respect to primary [correlations between endometrial thickness and EFC volume] and secondary [correlations between demographic characteristics and EFC volume] outcomes

Results: There was no correlation between EFC volume and single-layer endometrial thickness [P = 0.36]. Likewise, demographic characteristics were not related to EFC [P > 0.05]. However, both EFC volume and single-layer endometrial thickness were thicker in Group-I compared to Group-II [4.8 +/- 1.9 mm vs. 3.7 +/- 2.5 mm; and 5.7 +/- 9.4 mm vs. 2.7 +/- 2.5 mm, respectively] [P values were < 0.05]

Conclusion: Although a cutoff value for endometrial thickness and EFC volume could not be recommended based on our study findings, it should be noted that 2% is a clinically significant rate of malignancy. Thus, postmenopausal patients with EFC should be evaluated for endometrial sampling

Efeito do tamoxifeno sobre o endométrio em pacientes com câncer de mama na pós-menopausa / Effect of tamoxifen on the endometrium in post-menopausal patients with breast cancer

O trabalho tem como objetivo discutir, através de uma revisão da literatura, as influências do tamoxifeno sobre as alterações do padrão endometrial em pacientes com câncer de mama na pós-menopausa. Além de caracterizar os principais padrões endometriais e relacioná-los ao câncer de endométrio, são descritas também as recomendações da literatura vigente para a monitorização e seguimento destas pacientes. A literatura especializada demonstra claramente a relevância do acompanhamento clínico rigoroso destas mulheres pelo risco aumentado de câncer endometrial; no entanto, ainda não há consenso sobre qual o melhor exame de rastreio ou a periodicidade de realização do mesmo. Conclui-se que a prioridade é o exame clínico anual e orientação das pacientes quanto à sintomatologia, principalmente quanto à presença de sangramento vaginal. A partir destes sintomas, dá-se prosseguimento com investigação mais detalhada.(AU)

The present work aims to discuss, through a literature review, the influence of tamoxifen use in endometrial pattern changes in postmenopausal patients with breast cancer. In addition, to characterize the main endometrial patterns and relate them to endometrial cancer was a secondary objective. This review describes the recommendations of the current literature for endometrial monitoring of these patients. The literature clearly demonstrated to be relevant the clinical monitoring of these patients, because the increased risk of endometrial cancer. However, there is no consensus about which is the best tracking exam or the timing of completion of it. It was concluded that the priority is an annual clinical checkup for symptoms, especially the presence of vaginal bleeding; further, detailed investigation will depend on which symptoms are presented.(AU)

A Study of Endometrial Pathology by Transvaginal Color Doppler Ultrasonography and its Correlation with Histopathology in Post-menopausal Women.

Objective: Endometrial carcinoma is the most common gynaecological malignancy. Approximately 80% of endomentrial carcinoma occur in post-menopausal women. Present study aimed to evaluate the role of transvaginal ultrasonography and colour flow imaging in diagnosing endometrial pathologies especially endometrial carcinoma and later its confirmation by histopathology. Methods: 38 women presenting with history of at least 6 months amenorrhoea followed by bleeding per vaginum were included in the study. Transvaginal colour Doppler (TVS) followed by fractional curettage was done in all cases and cervical biopsy was done in selected cases. Uterine size, endometrial thickness and blood flow indices (RI, PI) were measured. Analysis of data was done using ‘z’ test and ‘t’ test. Results: Out of 38 women maximum number of cases (39.47%) were between 50 – 55 years. Using 4 mm of endometrial thickness as cut off value for discriminating normal and abnormal endometrium, sensitivity, specificity, PPV and NPV were 94.12%, 50%, 95.12% and 50% respectively (p < 0.05). No case of endometrial carcinoma was detected when the endometrium was <4 mm, making the sensitivity as 100%, NPV 100%, specificity 13.33% and PPV 23.53%. Using RI = 0.81 as cut off value for discriminating benign and malignant endometrium, sensitivity was 62.5%, specificity 53.33%, PPV – 26.3% and NPV as 84.2%. Conclusion: Transvaginal sonographic (TVS) evaluation of endometrial thickness (ET) is a reliable method of screening women with post-menopausal bleeding. Conservative approach may be offered to women showing ET of less than 4 mm and high impedance to flow in uterine and endometrial vessels.

Various hysterosalpingography findings of female genital tuberculosis: a case series

Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography [HSG]. The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis

Evaluation of Intrauterine structural pathology by three-dimensional sonohysterography using an extended imaging method

Structural intrauterine abnormalities are an important cause of infertility, recurrent pregnancy loss and bleeding or pain associated with a poor reproductive outcome. Various diagnostic methods have been applied to detect these lesions such as hysterosalpingography, hysteroscopy and sonohysterography. More recently, three-dimensional extended imaging [3DXI] provides the ability to obtain sequential sections of acquired volume scans in A, B and C planes. Here, we briefly discuss the technique of saline infusion sonography, followed by a review of sonohysterographic characteristics of intracavitary pathologies with more focus on some definitions and measurements

Effects of steroid hormone levels on the ultrasound appearance of the preovulatory endometrium in controlled ovarian hyperstimulation cycles

Background: This study investigated the effects of serum estradiol [E2] and progesterone levels on preovulatory endometrial thickness and echogenicity in controlled ovarian hyperstimulation [COH] cycles for in vitro fertilization [IVF]

Materials and Methods: In this retrospective study, we evaluated the data of 241 in vitro fertilization-embryo transfer cycles. Cycles were classified into three groups according to endometrial thickness measured on the day of human chorionic gonadotropin [hCG] administration as: i./=14 mm. Echogenic patterns were described as trilaminar, isoechogenic, and hyperechogenic. Serum E2 and progesterone levels were evaluated on the day of hCG administration. Data were analyzed using chi-square test, Student's t test and analysis of variance [ANOVA]

Results: Serum E2 levels increased in parallel with endometrial thickness, although differences among the three groups were insignificant. There was no correlation between serum progesterone levels and endometrial thickness. There was no significant difference in the steroid hormone concentrations between the echogenic patterns

Conclusion: Serum steroid hormone levels on the day of hCG administration do not affect the ultrasound appearance of the endometrium in COH cycles

Correlation between endometrial parameters in doppler sonography and success rate of implantation in assisted reproductive programs

A good blood supply towards the endometrium is usually considered to be an essential requirement for implantation. Evaluating the role of endometrial and sub-endometrial blood flows detected by color Doppler sonography at the day of embryo transfer, as a predictor of pregnancy rate during IVF/ICSI programs was our main goal in this study. Seventy three infertile patients aged <38 years with basal serum FSH level<12 mIU/ml who had less than two failed attempts of ART cycles were prospectively evaluated. The cases with more than two failed IVF cycle and uterine disorders were excluded. All procedures were performed by one expert and two good quality embryos were transferred. Vaginal power color Doppler sonography was performed at the day of embryo transfer and endometrial characteristics including endometrial vascularization, area of vascularization distribution and pulsatility index were registered. Then pregnant and non-pregnant groups were compared for ultrasonographic parameters of endometrium Pregnancy occurred in 28 patients. Mean age, duration and etiology of infertility, baseline mean FSH and estradiol level at the day of Human chorionic gonadotropin [HCG] injection, amount of drug administered, number of retrieved oocytes and embryos, also number and quality of transferred embryos in the pregnant and non-pregnant groups showed no statistically significant difference. On the other hand, none of the sonographic parameters reported in two groups indicated a statistically significant difference. Doppler ultrasonographic indices at the day of embryo transfer are not considered appropriate criteria for prediction of success rate or failure of embryo implantation

value of transvaginal sonography performed before diagnostic hysteroscopy for the evaluation of uterine cavity in infertile women

Hysteroscopy have gained general acceptance as a method for the investigation of infertility. The main advantage of hysteroscopy is the capability of inspecting the uterine cavity. Transvaginal sonography [TVS] is a noninvasive modality that provide excellent imaging of the uterus and of endometrial abnormalities. The present study was designed to evaluate the use of TVS as the initial diagnostic procedure before hysteroscopy for detecting intrauterine disorders. Seventy-eight infertile women were examined by TVS and diagnostic hysteroscopy in the late follicular phase of the menstrual cycle and the results were compared. The uterine cavity abnormalities were present in 19.2% of the infertile females involved in the study. The Transvaginal scnography had 87.5% sensitivity, 100% specificity for detecting endometrial polyps while it had 100% sensitivity and 100% specificity for detecting other intrauterine cavity abnormalities including intrautcrine adhesions, uterine septae and submucosal myomas. Examination of the uterine cavity is an integral part of any thorough evaluation of an infertile woman. Tranavaginal sonography, when performed during the follicular phase, can detect most uterine cavity abnormalities. It was an accurate tool in the identification of intrauterine adhesions, uterine septae and submucosal fibroids

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

Predicting endometrium receptivity with parameters of spiral artery blood flow / 华中科技大学学报（医学）（英德文版）

In order To evaluate whether the parameters of spiral artery blood flow, as measured by transvaginal color Doppler, may be used to assess endometrium receptivity prior to embryo transfer (ET), a retrospective study of 94 infertile women who had undergone ART treatments with different outcomes (pregnant or nonpregnant) was done. Subendometrial blood flow was evaluated. The resistance index (RI), systolic/diastolic ratio (S/D) and pulsatility index (PI) were significantly lower in those who achieved pregnancy as compared with those who did not: 0.62+/-0.04 vs 0.68+/-0.04 (P0. 2, PI>1. , and S/D>3. , no pregnancy occurred. These data suggest that the parameters of spiral artery blood flow could be used as a new assay in predicting endometrial receptivity before ET.

Role of saline infusion sonohysterography in diagnosing endometrial polyps

Study carried out in Radiology Department of Jinnah Hospital Lahore on four patients with age ranges from 3546 years revealed that the Saline Infusion Sonohysterography plays an important role in diagnosing endometrial abnormalities especially Endometrial Polyps in women's with complaint of intermenstural bleeding. Saline Infusion Sonohysterography requires minimal patient's preparation, has few complications and is well tolerated by patients. Given its advantages over other techniques for uterine evaluation, Saline Infusion Sonohysterography will play an even larger role in pelvic imaging in future

Luteal phase endometrial echo-pattern in predicting pregnancy outcome during in-vitro fertilization and embryo transfer

The objective of this study was to evaluate the relationship between the sonographic assessment of the endometrium in the luteal phase and the in vitro fertilization embryo transfer outcome. Sixty-six women undergoing in vitro fertilization ET [IVF-ET] and another 66 women undergoing frozen embryo transfer [FET] were included in this study. All women underwent transvaginal ultrasound evaluation of the endometrial thickness and echogenic pattern three days after their embryo transfer. The 132 evaluated cycles were classified into two groups: Those with homogeneous hyperechogenic [HH] endometrial pattern and those with non-homogeneous hyperechogenic pattern [non- HH]. The clinical pregnancy rates were 31% versus 14%, the live birth rates were 24% versus 9%, the implantation rates were 14% versus 4% and the miscarriage rates were 21% versus 33% in HH and non-HH cycles in the IVF-ET group. There were no statistical differences between the pregnancy outcomes and echo-pattern in the FET group of women. There were no significant differences in age, number of oocytes retrieved, fertilization rate or the number of embryos transferred between conception and non-conception cycles in IVF-ET

Value of transvaginal ultrasonography in the diagnosis of endometrium abnormalities in patients treated with tamoxifen

This study was conducted to investigate the value of endovaginal ultrasound in the assessment of tamoxifen associated changes of the endometrium in patients with breast cancer and to correlate sonographic and pathologic findings to symptoms and duration of tamoxifen therapy. Medical records and sonograms of 80 post-menopausal women treated for cancer breast with adjuvant tamoxifen therapy were reviewed retrospectively. Endometrial thickness was recorded as a single layer thickness and considered abnormal when greater than 2.5 mm for post-menopausal women. Sonographic endometrial thickness was correlated to histologic findings, symptoms and duration of tamoxifen therapy. Fifty seven of 80 post-menopausal women had single layer endometria1 thickness of 2.5 mm or greater measured by TVS and 55 of 57 had endometrial biopsies or dilatation and curettage. Biopsies detected 24 cases of abnormal endometrial including endometrial carcinoma [2], breast carcinoma metastatic to the endometrium [one], endometrial polyps [13], tuba1 metaplasia [3] and benign endometrial hyperplasia [5]. Using a single- layer endometrial thickness greater than 2.5 mm by TVS, 21 of 24 women with abnormal endometrial were detected. Women with abnormal pathologic findings had a significantly thicker mean single layer endometrial thickness than those with normal findings [7 mm versus 4 mm]. Twelve women had post-menopausal bleeding all of whom had a single layer endometrial thickness greater than 2.5 mm on TVS