Relation of serum estrogen level to endometrial abnormalities and uterine blood flow in cases of post menopausal bleeding

Post menopausal women are subject to various endometrial changes, this study was done to determine the relation between endometrial thickness, abnormalities and uterine blood flow, to the serum estrogen level in cases of postmenopausal bleeding. The study was carried out for Two years period May 2005-Apr 2007 including 50 patients with postmenopausal uterine bleeding, examined by transvaginal ultrasound to assess the endometrial thickness and echogenicity; Color Doppler imaging was used to evaluate blood flow velocity through both uterine arteries and Pulsatility Index [PI] to analyze the waveform; Serum estrogen level was measured to all cases using the Radio-immunoassay [RIA] technique, The normal value of serum estrogen in postmenopausal women is 5-25 pg/ml. Dilatation and curettage was done to study the endometrial and endocervical histopathological feature. TVS and measurement of serum E2 were used as a screening tests for the detection of postmenopausal endometrial hyperplasia and/or malignancy. Doppler flow mapping for the uterine arteries and histopathological evaluation further added as complementary parameters. Endometrial hyperplasia was reported in 22 cases [44%] and endometrial cancer in 12 cases [24%]. The hyperplasia group further classified into simple, complex and atypical. Simple hyperplasia recorded in 12 cases [24%], complex in 7 cases [14%], and atypical in 3 cases [6%]. Endometrial polyp was seen in 5 cases [10%], Endometrial atrophy was seen in 7 cases [14%], while fibroid was seen in 4 patients [8%]. Assessment of the endometrium by TVS and measurement of serum E2 should be used as a primary diagnostic simple screening tests for the detection of postmenopausal endometrial hyperplasia and/or malignancy; But they must be supplemented by Doppler sonography of the uterine arteries whenever the serum E2 level is above normal or endometrial thickness is more than 5 mm in order to detect cancer at an early stage

Efficacy of pipelle as a tool for endometrial biopsy

This study was carried out to determine the accuracy of Pipelle sampling in the diagnosis of abnormal uterine bleeding by comparing it with histopathology of the hysterectomy specimens taken as gold standard. One hundred patients with abnormal uterine bleeding in perimenopausal or postmenopausal age group scheduled for hysterectomy had endometrial sampling with Pipelle, in the department of Obstetrics and Gynaecology Unit I, Sir Ganga Ram Hospital, Lahore, from Dec. 2003 to Dec. 2004. The specimens were sent for histopathology. Among 100 patients, 66 underwent hysterectomy. In the remaining 34 patients, 6 had inadequate specimen on Pipelle sampling and in 28 patients hysterectomy was planned but postponed because of medical problems. Among the 66 patients the results of Pipelle Endometrial Sampling [PES] were compared with histological results of hysterectomy specimen. Among the 66 patients the results of PES were compared with the histological results of hysterectomy specimen. In 61 cases the histopathological results were identical indicating a correlation of 92.42%. In 5 cases results were different, 4 having slight variation and in one case PES reported complex hyperplasia and on hysterectomy it turned out to be a case of carcinoma cervix. It is concluded that Pipelle biopsy is definitely a useful and cost effective method. It can reduce the number of D and C performed in the theatre. Moreover it has an advantage of taking biopsy on the first visit of patient thereby time taken for the diagnosis of malignancy can be reduced

Sensibilidade e especificidade da histerossonografia nas afecções endometriais em mulheres assintomáticas pós-menopausa / Sensitivity and specificity of hysterosonography in endometrial abnormalities in asymptomatic postmenopausal women

OBJETIVOS: 1) Estimar sensibilidade e especificidade da histerossonografia nas afecções endometriais, utilizando-se como padrão-ouro a histeroscopia diagnóstica; 2) comparar concordância entre a ultra-sonografia, a histerossonografia e a histeroscopia através do índice de Kappa (K). MÉTODOS: Foram estudadas 50 mulheres assintomáticas após menopausa, todas tinham suspeita de afecções endometriais pela ultra-sonografia transvaginal e, por isso, complementaram avaliação endometrial com a histerossonografia, a histeroscopia diagnóstica e a biópsia orientada. Para comparação dos resultados entre esses exames utilizou-se índice de Kappa. RESULTADOS: Afecções endometriais mais freqüentes: pólipos (58 por cento), sinéquias (20 por cento), mioma submucoso (12 por cento) e espessamento endometrial (6 por cento). Cavidade normal (4 por cento) dos exames histeroscópicos. A sensibilidade da histerossonografia para diagnóstico de pólipo foi de 89,7 por cento; a especificidade de 81 por cento e o (K) de 71,1 por cento. Para sinéquia a sensibilidade foi de 80 por cento, a especificidade 100 por cento e o (K) de 86,5 por cento; para mioma submucoso: a sensibilidade foi de 83,3 por cento; a especificidade de 97,7 por cento e o (K) de 81,1 por cento e para espessamento endometrial a sensibilidade foi de 33,3 por cento, a especificidade de 89,4 por cento e o (K) de15,5 por cento. CONCLUSÕES: A histerossonografia apresentou ótima concordância com a histeroscopia para sinéquias e miomas submucosos; boa concordância para pólipo e péssima concordância para espessamentos endometriais. Revelou-se, também, tratar-se de método simples, eficiente e que pode ser utilizado para a avaliação da cavidade uterina em mulheres após menopausa.

Transvaginal sonography for identifying endometrial abnormalities in pre and postmenopausal women with abnormal uterine bleeding

In a prospective study, eighty pre and postmenopausal patients underwent transvaginal sonography, hysteroscopy and endometrial sampling through D and C. The ultrasonographic findings were evaluated on basis of final diagnosis established by hysteroscopy and histologic examination. In 41 premenopausal women, transvaginal sonography using a cut off point of 5 mm of the single-layer endometrial thickness demonstrated a sensitivity in diagnosing endometrial abnormalities of 85% and a specificity of 62%. The positive likelihood ratio was 0.24. In 39 postmenopausal women using a cut off point of 3 mm; sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 94%, 66%, 2.7% and 0.09, respectively

Alteraçöes morfológicas em útero, tubas e ovários de égua. I. Cistos endometriais / Morphological changes in the uterus, tubes and ovarian in mares. I. Endometrial cysts

Em 160 éguas näo gestantes, com idade de dois a 21 anos e abatidas em matadouros, diagnosticaram-se macroscopicamente e microscopicamente 24 (15 por cento) casos de cistos endometriais. Todos eram de origem linfática, mais frequentes nas éguas velhas e comumente associados à endometrite crônica ou à lacunas linfáticas

Endometriosis atopica: presentacion de 3 casos y revision de la entidad / Atopic endometriosis: presentation of 3 cases and review of the entity

En el presente articulo revisamos la etiopatogenia y presentacion clinica de la endometriosis haciendo hincapie en las localizaciones atopicas, reforzando lo anterior hacemos la presentacion de 3 casos diagnosticados y tratados en el servicio de obstetricia y ginecologia del hospital San Gabriel en el periodo comprendido entre el primero de enero al 31 de julio de 1994, en pacientes de consulta externa cuyas manifestaciones clinicas estuvieron relacionadas con la via de obtencion del producto de la concepcion.

Hiperplasia endometrial

El presente artículo es una revisión de la epidemiología, etiopatogenia, diagnóstico y tratamiento de la hiperplasia endometrial, en donde se pretende entregar al especialista una actualización de la clasificación, un esquema específico de manejo y seguimiento de esta condición, para que pueda hacer un enfoque más racional de la hiperplasia endometrial