Hysteroscopically directed endometrial biopsy versus full endometrial curettage in perimenopausal bleeding

Hysteroscopically guided biopsy was evaluated versus full curettage biopsy in 50 patients presented with perimenopausal bleeding. The presenting symptom was metrorrhagia in 58%, menometrorrhagia in 24% and menorrhagia in 18% of cases. Two specimens of the hysteroscopic directed biopsies were unfit for histopathologic examination Endometrial hyperplasia was diagnosed in 66% of the hysteroscopic biopsies and 74% of the full curettage biopsies. The overall diagnostic efficacy of hysteroscopic biopsy in diagnosing endometrial pathology was 84% for simple endometrial hyperplasia 92% for cystic endome trial hyperplasia, 96% for regressive hyperplasia, and 88% for proliferative endometrium. There was an agreement between the two procedures in 76% of cases. Hysteroscopy revealed more informations in 24% of cases

Significance of negative hysteroscopic view in abnormal uterine bleeding.

Ninety six cases of abnormal uterine bleeding were evaluated by both panoramic hysteroscopy and dilatation and curettage. The indications for hysteroscopy included postmenopausal bleeding, infertility with abnormal bleeding, abnormal bleeding and suspected leiomyoma with bleeding. Twenty three patients had abnormal hysteroscopy findings. Hysteroscopy diagnosed endometrial polyp and submucus leiomyoma with 100% accuracy. In 17 cases, the results of hysteroscopy and curettage were in agreement and hysteroscopy revealed more information than curettage in 6 cases. Among the remaining 73 cases with 'negative' hysteroscopic view, an abnormality was detected by tissue sampling in only 2 patients. The specificity and positive predictive value of hysteroscopy is 100%. The sensitivity of hysteroscopy was greater (92%) than that of curettage (76%) and the negative predictive value of hysteroscopy was 2.8%. Thus, panoramic hysteroscopy may prove to be superior to curettage in making an accurate diagnosis of intrauterine pathology.

Anestesia endovenosa en curetaje uterino -Comparación etomidato, clonazapan-tiopental-ketamina, tiopental-midazolan, ketamina-fentanyl y tiopental

Se analizan 118 pacientes sometidas a curetaje uterino, sanas por lo demás, en cuento a su comportamiento hemodinámico y de calidad anestésica en 5 técnicas anestésicas endovenosas diferentes, distribuidas en cinco grupos: Clonazepan-fentanyl-etomidato, tiopental, midazolam-ketamina, tiopental-ketamina y fentanyl-tiopental. La asociación fentanyl-tiopental mostró ser la más estable hemodinámicamente y tener la menor cantidad de efectos secundarios; el etomidato es comparativamente tan hemodinámicamente estable como fentanyl-tiopental, pero la presencia de mioclonias y el riesgo de convulsiones son limitantes impòrtantes. La ketamina produce cambios hemodinámicos y efectos psicotomiméticos que no fueron controlados adecuadamente por el fármaco asociado, y son incluso potenciados por el tiopental. El tiopental produce grandes variaciones hemodinámicas como reflejo de su efecto cardiodepresor. Se recomienda hacer un nuevo estudio comparativo con otros fármacos y a mayores dosis de las usadas por nosotros