Diagnosis of venous thromboembolism in pregnancy: a review of current guidelines.

Venous thromboembolic disease (VTE) is the leading cause of maternal death throughout the developed world. International and national guidance for the diagnosis and management of VTE in pregnancy is varied and limited, which can result in problems in clinical practice. The imaging challenges of VTE in the general population are challenging but become more complex in pregnancy due to the physiological changes in the circulatory system, which alter clinical judgment and test performance. As an additional factor, the relative radiation risks to the mother and fetus arising from diagnostic tests need to be assessed and communicated to the patient in a clear and understandable way. The purpose of this review is fourfold. We propose to review and summarise the current imaging guidelines available for this condition; critically review the evidence base within the current literature; address the issues of test performance of imaging examinations used for VTE in pregnancy; and address the question of radiation risk and how to communicate this information to patients.

Cytomorphological assessment of benign and malignant dense hyperchromatic groups in cervicovaginal smears.

Dense hyperchromatic cell groups are considered common diagnostic problems in cytopathological evaluations. Clusters of cells with scant cytoplasm and dark nuclei represent the morphological features of dense hyperchromatic cells. Cytological evaluations of the dense hyperchromatic groups in cervicovaginal smear results in high rates of false-positive or false negative diagnosis. The key element is to differentiate among the dense hyperchromatic groups and to appropriately classify, based on strict morphologic criteria. The objective of this study was to evaluate the cytomorphology of benign and malignant dense hyperchromatic groups in cervicovaginal smears reported at the University of Mississippi Medical Center. Six distinct types of dense hyperchromatic groups were selected (forty-eight cervicovaginal smears) to represent all of the entities. The cases were divided into; group 1; atrophic pattern (n = 9), group 2; endocervical cells (n = 9); group 3, endometrial cells (n = 10), group 4; high-grade squamous lesions (HSIL)(n = 10), group 5; squamous cell carcinoma (n = 5), and group 6; endometrial adenocarcinoma (n = 5). Light microscope techniques were used to evaluate several parameters--such as, background, arrangement, and chromatin pattern. ImagePro digital analysis computer software (at x40 magnification) was used to quantify and evaluate the nuclear area and nuclear to cytoplasm ratio. Data obtained from this investigation suggest that there were significant differences observed in the total nuclear areas among all groups. In conclusion, cytomorphometric analysis can be utilized as an ideal diagnostic tool in differentiating between the ambiguous or suspicious groups of dense hyperchromatic cells. Ultimately, this diagnostic tool can minimize the rate of false-positive or false-negative diagnosis resulting in better cytologic evaluations and patient management.