ABSTRACT
STUDY OBJECTIVE: To compare 2-dimensional sonohysterography (2D SHG) vs 3-dimensional sonohysterography (3D SHG) using saline solution infusion, with outpatient hysteroscopy as the gold standard, for evaluation of the uterine cavity in women of reproductive age. DESIGN: Comparative observational cross-sectional study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred twenty women of reproductive age with abnormal uterine bleeding, infertility, or recurrent pregnancy loss and with clinically and/or ultrasongraphically suspected intrauterine lesions. INTERVENTIONS: All patients underwent 2D SHG and 3D SHG using saline solution infusion followed by outpatient hysteroscopy. Sonographic findings were compared with hysteroscopic findings. MEASUREMENTS AND MAIN RESULTS: For 2D SHG, sensitivity was 71.2%; specificity, 94.1%; positive predictive value, 90.2%; negative predictive value, 81.0%; and overall accuracy, 84.2%. For 3D SHG, sensitivity was 94.2%; specificity, 98.5%; positive predictive value, 98.0%; negative predictive value, 95.7%; and overall accuracy, 96.7%. Thus, 3D SHG was superior to 2D SHG (p = .02) and comparable with outpatient hysteroscopy (p = .12) for diagnosis of intrauterine lesions. CONCLUSION: 3D SHG can be used in the initial evaluation of the uterine cavity in women of reproductive age, with accuracy comparable to that of hysteroscopy.
Subject(s)
Imaging, Three-Dimensional , Uterine Diseases/diagnostic imaging , Uterus/diagnostic imaging , Abortion, Habitual/etiology , Adult , Cross-Sectional Studies , Female , Humans , Hysteroscopy , Infertility, Female/etiology , Metrorrhagia/etiology , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Sodium Chloride , Ultrasonography , Uterine Diseases/complications , Uterine Diseases/diagnosisABSTRACT
BACKGROUND: Hepatic fibrosis and cirrhosis develop progressively in extrahepatic biliary atresia (EHBA) despite timely surgical intervention. PURPOSE: The aim of the study was to define CD4+ helper T lymphocytes, cytotoxic CD8+ T lymphocytes, and CD68+ (macrophages) infiltration of portal tracts and lobules and hepatic fibrosis as possible predictive measures of outcome of infants having EHBA. METHODS: The outcome of 32 infants with EHBA was correlated to their percutaneous biopsy and postportoenterostomy core liver tissue infiltration by CD4+, CD68+, and CD8+ cells and to the degree of detected fibrosis. RESULTS: Portoenterostomy cores were heavily infiltrated by CD4+, CD8+, and CD68+, compared with the preoperative liver biopsy (P = .008, .004, and .017, respectively). Infants having favorable outcome had more macrophage infiltration in portoenterostomy core compared with those having an unfavorable outcome (25.66 +/- 29.77 per HPF compared with 11.62 +/- 4.58, P = .000). Mean CD4+/CD8+ ratio was 1.54 +/- 1.37 in those who died within 18 months postoperatively and 0.733 +/- 0.48 in others (P = .021). CONCLUSION: Immune-mediated destruction of portal tracts is an integral part of pathogenesis of EHBA.
