comparison of isosorbide mononitrate, misoprostol and combination therapy for preinduction cervical ripening at term: a randomized controlled trial

The purpose of this study was to compare the efficacy, safety, and acceptability of isosorbide mononitrate [IMN], misoprostol, and the combination therapy for cervical ripening before induction of labor at term. A prospective, double-blind, placebo-controlled, randomized clinical trial in 196 term and post-term nulliparous women with unfavorable cervices who were assigned randomly to receive either 40mg of IMN [n=65], 50 micro g of misoprostol [n=65], or both of them [n=66] in the posterior vaginal fornix. Changes in Bishop score and cervical length, progress and outcomes of labor and adverse effects were assessed. The combination therapy was more effective than IMN or misoprostol. Successful induction [vaginal delivery within 24 h of initiation of cervical ripening] was significantly higher in the misoprostol [60%] and combination therapy [62.1%] groups compared with the IMN [27.7%] group [P<0.0001]. Mean duration [h] from treatment initiation to delivery was greater for IMN [26.7 +/- 7.5] than misoprostol [16.5 +/- 6.7] and combination therapy [14.8+6.2] groups [P<0.0001]. Oxytocin was needed more in the IMN group [93.8%] than in the misoprostol [21.5%] and combination therapy [25.8%] groups [P<0.0001]. IMN was safer and more acceptable than misoprostol and combination therapy. The cesarean rate was not significantly different among groups, but the major indications were different: dystocia [54.5%] in the IMN group versus persistent non-reassuring FHR pattern [57.9%] in the misoprostol and [47.6%] in the combination therapy groups [P=0.01]. The combination therapy was more effective than either IMN or misoprostol alone for preinduction cervical ripening at term. However, IMN was safer, well tolerated and more acceptable

Utility of ultrasonography in the evaluation of renal scarring using dimercaptosuccinic acid scan as the gold standard

Dimercaptosuccinic acid [DMSA] is considered the most sensitive tool for diagnosis of renal scars. This study was done to evaluate the utility of renal ultrasound scanning in detection of renal scars in children with urinary tract infection [UTI] compared to DMSA scan as the gold standard. During 4 years period, we evaluated 202 children with UTI for detection of renal scars using ultrasound and DMSA renal scanning. All patients underwent renal ultrasound and DMSA scan for detection of renal scars. Renal scars were classified into diffuse or focal types. The data were statistically analyzed to evaluate the sensitivity and specificity of renal ultrasound in detection of renal scars. Two hundred and two patients [404 renal units] scanned with ultrasound and DMSA for detection of renal scars. Male to female ratios were 1:1.8 [71 males and 131 females]. DMSA proved the presence of scars in 145 units [35.89%], Ultrasound was able to detect scars in 52 units out of 145 with sensitivity; specificity, PPV, and NPV ultrasound in detection of scars were 35.68%, 91.12%, 69.33%and 71.73%, respectively. DMSA scan detect focal scars in 85 units while diffuse one in 60 units. Ultrasound was able to detect focal scars in 20 out of 85 units [23.5%] with sensitivity, specificity, PPV, and NPV were 23.5%, 94.3%, 52.6% and 82.2% respectively. While diffuse scars in 32 units out of 60 [53.3%] with sensitivity, specificity, PPV, and NPV were53.3%, 98.5%, 86.5%and 92.5%, respectively. Although ultrasonography has a good specificity for detection of renal scarring compared with DMSA scan. Ultrasonography cannot replace DMSA scan in the evaluation of focal renal scarring. However ultrasound might be used for selection of the cases that should be underwent DMSA renal scan

Optimizing the accuracy of transvaginal ultrasonography of the endometrium: a power doppler study in women with postmenopausal bleeding

Objective: To assess the diagnostic value of power Doppler ultrasonography in evaluating endometrial pathology in women with postmenopausal bleeding

Methods: A cross sectional study included sixty nine women with postmenopausal bleeding. All patients had power Doppler study of uterine and endometrial vessels as well as endometrial thickness measurements

Results: The mean endometrial thickness in patients with non-neoplastic endometrial pathology was significantly different from those with neoplastic pathology [5.9+/- 3.7mm, versus 13.2+/- 5.1mm, P< 0.001]. There was no significant difference in the mean +/- SD RI and PI of uterine artery between patients with neoplastic and non-neoplastic endometrium. There was statistically significant difference in the rate of positive visualization of endometrial blood flow between cases of neoplastic endometrium [41.4%] and non-neoplastic one [2.5%] [P< 0.001]. Meanwhile, endometrial artery RI was significantly different when compared between cases of neoplastic pathology [0.56 +/- 0.07] and non-neoplastic pathology [0. 65 +/- 0.09] [P < 0.05]

Conclusion: Power Doppler ultrasonic evaluation of endometrial blood flow may contribute to the correct diagnosis of endometrial disease in symptomatic postmenopausal patient and is considered a specific non invasive procedure that may limit the need for endometrial biopsy procedure to some particular patients