Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study.

OBJECTIVE: To investigate how many examinations it takes to be able to identify the pelvic parts of the ureters on transvaginal sonography (TVS). METHODS: This was a prospective study including consecutive women attending a gynecological outpatient clinic in a tertiary referral setting. Prior to commencement of the study, three trainees, with a focus on gynecological surgery and TVS but with no experience in identifying ureters, each observed an expert examiner performing 10 routine TVS examinations, including identification of both ureters. All were standardized gynecological TVS examinations, with visualization of the pelvic part of both ureters. Consecutive women were then examined, first by the expert, unobserved by the trainees, and then by one of the three trainees, in the presence of the expert. To ensure that identification of the pelvic parts of the ureters could be incorporated feasibly into routine gynecological TVS in a tertiary referral setting, a time limit of 150 s was set for successful identification of each ureter. A successful examination was defined by identifying both ureters within the time limit. The number of women examined by each trainee was determined by how quickly they achieved proficiency, which was evaluated using the learning curve cumulative summation (LC-CUSUM) score. RESULTS: Between January 2017 and June 2017, a total of 140 women were recruited for the study, with 135 patients being included in the final analysis. The three trainees were able to identify the right ureter after a maximum of 48 (range, 34-48) TVS examinations, and the left ureter after a maximum of 47 (range, 27-47) TVS examinations. CONCLUSIONS: Sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40-50 TVS examinations. Detection of the ureters is a feasible part of the TVS workup of patients attending a clinic in a tertiary referral center. © 2019 the Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Curva de aprendizaje para la detección de las partes pélvicas de los uréteres mediante ecografía transvaginal: estudio de viabilidad OBJETIVO: Investigar cuántos exámenes se necesitan para poder identificar las partes pélvicas de los uréteres en la ecografía transvaginal (ETV). MÉTODOS: Se trata de un estudio prospectivo que incluyó a mujeres que acudieron consecutivamente a una clínica ginecológica ambulatoria en un entorno de especialistas terciarios. Antes de comenzar el estudio, tres pasantes con interés en la cirugía ginecológica y la ETV pero sin experiencia en la identificación de uréteres, observaron respectivamente a un examinador con experiencia mientras realizaba 10 exámenes rutinarios de ETV, incluida la identificación de ambos uréteres. Todos eran exámenes ginecológicos estandarizados por ETV, con visualización de la parte pélvica de ambos uréteres. A continuación, las mujeres fueron examinadas en orden consecutivo, primero por el experto, sin ser observadas por los aprendices, y luego por uno de los tres aprendices, en presencia del experto. Para asegurar que la identificación de las partes pélvicas de los uréteres se pudiera incorporar de manera factible a la ETV ginecológica rutinaria en un entorno de especialistas terciarios, se fijó un plazo de 150 segundos para la identificación satisfactoria de cada uréter. El éxito del examen se definió mediante la identificación de ambos uréteres dentro del plazo establecido. El número de mujeres examinadas por cada aprendiz se determinó por la rapidez con que alcanzaron la competencia, que se evaluó utilizando la puntuación de la suma acumulativa de la curva de aprendizaje (LC-CUSUM, por sus siglas en inglés). RESULTADOS: Entre enero y junio de 2017, se reclutó un total de 140 mujeres para el estudio, y 135 de ellas se incluyeron en el análisis final. Los tres aprendices pudieron identificar el uréter derecho después de un máximo de 48 (rango, 34-48) exámenes de ETV, y el uréter izquierdo después de un máximo de 47 (rango, 27-47) exámenes de ETV. CONCLUSIONES: Los ecografistas y/o ginecólogos que están familiarizados con la ETV ginecológica deberían ser capaces de llegar a ser competentes en la identificación de ambos uréteres después de 40-50 exámenes de ETV. La detección de los uréteres es una parte factible de la ETV de los pacientes que acuden a una clínica en un centro de especialistas terciario. © 2019 Los autores. Ultrasonido en Obstetricia y Ginecología publicado por John Wiley & Sons Ltd. en nombre de la Sociedad Internacional de Ultrasonido en Obstetricia y Ginecología.

[Bronchial tuberculosis in the elderly: apropos of 9 cases. Radioclinical, endoscopic and developmental aspects]. / Tuberculose bronchique chez la personne âgée: à propos de neuf cas. Aspects radiocliniques, endoscopiques et évolutifs.

We report nine cases of elderly French patients (more than 65 years old) with bronchial tuberculosis. We report the clinical features, radiological and endoscopic aspects. The symptoms are non specific and may delay the diagnostic. The chest X-ray and endoscopic aspects are tumor like. Retractile bronchial stenosis is a potential evolution.

Pharmacological characterization of tachykinin-induced intracellular calcium rise in a human NK2 receptor transfected cell line.

We have examined the effect of various natural and synthetic tachykinins on the steady state Ca(++)-rise ([Ca++]i) in transfected chinese hamster ovary cells expressing recombinant human Neurokinin 2 (NK2) receptors. The rank order of potency with natural tachykinins was NeurokininA > Neurokinin B > Eledoisin > Physaelamin > substance P. The selective NK2 agonist, [beta-Ala8]NKA(4-10) was very potent, with an EC50 value of 4.83 x 10(-9) M whereas Senktide, MePhe7NKB and Sar9, (MetO2)11 substance P, selective NK3 and NK1 agonists, respectively, did not have any effect on [Ca++]i in hrNK2CHO cells, suggesting a selective and preferential recognition and activation of NK2 receptors in these cells. (+/-) SR 48968, a selective NK2 antagonist, abolished the beta-AlaNKA-induced [Ca++]i with an IC50 value of 0.7 nM. Two other peptidic NK2 antagonists, MEN 10376 and L-658977, were less active with IC50 values of 49 nM and 5.29 microM, respectively. In contrast, (+/-) CP-96,345 and (+/-)CP-99,994 and RP 67580, all selective NK1 antagonists, did not have any effect on the beta-AlaNKA-induced [Ca++]i in hrNK2CHO cells (+/-) SR 140333, a potent and selective NK1 antagonist, had a 35% inhibition under similar conditions. These data demonstrate a high selectivity and sensitivity to NK2 receptor mediated [Ca++]i in rhNK2R-CHO cells and may be of value as a rapid, selective test of drug action at the human NK2 receptors in vitro.

[Catamenial pneumothorax]. / Pneumothorax cataménial.

Pulmonary endometriosis has been described as occurring in two forms: --bronchopulmonary with haemoptysis at the periods, --pleuropulmonary with pneumothorax at the periods. In 30-40% of cases it is associated with pelvic endometriosis. The pathways along which it can be disseminated are: --transdiaphragmatic peritoneal migration, --or metastatic migration through the veins and lymphatics. The treatment at present consists of hormone therapy together with surgery.

[Diffuse interstitial pneumonitis. Possible responsibility of amiodarone. Apropos of a case and review of the literature]. / Pneumopathie interstitielle diffuse. Responsabilité possible de l'amiodarone. A propos d'un cas, revue de la littérature.

We report the case of a 65 years old woman treated for 20 months with Amiodarone for angina who presented a picture of diffuse interstitial pneumonitis of rapid onset and of marked severity, which totally resolved once the drug was suspended and following the administration of steroid therapy. This raises the problem of the responsibility of Amiodarone in the aetiology of diffuse interstitial pneumonitis. We present 12 cases from the literature which also raise the question of the responsibility of this drug.

[Pleurisy and sarcoidosis. Apropos of a case]. / Pleurésie et sarcoïdose. A propos d'un cas.

The authors report a case of bilateral hilar lymphoma of sarcoid origin associated with a pleural effusion. With the exception of pneumothorax, the pleural manifestations in the course of sarcoidosis amount to 115 published cases, including 49 with histopathological proof enabling us to speak of a pleural sarcoidosis. When the histopathological diagnosis is missing, it is preferable to speak of sarcoidotic pleurisy: the aetiopathogenesis in this case is venous obstruction and/or lymphatic obstruction by sarcoid involved lymph nodes. Exceptionally, it could be due to heart failure due to the fibrotic stage of sarcoidosis or to an autonomous sarcoidotic myocarditis.