Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology.

OBJECTIVE: To correlate with histopathological features the adenomyosis-induced morphological alterations of the outer myometrium and the inner myometrium ('junctional zone', JZ) detectable on two- (2D) and three-dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis. METHODS: Premenopausal patients scheduled for hysterectomy for benign pathology were enrolled in this prospective study. Before hysterectomy all patients underwent detailed 2D-TVS and 3D volume acquisition of the entire uterus. The major sonographic signs of adenomyosis were noted. On the multiplanar coronal and longitudinal views obtained by 3D-TVS we measured the maximum and minimum JZ thickness from the basal endometrium to the internal layer of the outer myometrium (JZmax, JZmin), the difference between them (JZdif = JZmax - JZmin) and the ratio JZmax/total maximum myometrial thickness. Results of these examinations were correlated blindly to the presence of adenomyosis on histological specimens. RESULTS: A total of 72 premenopausal patients underwent 2D- and 3D-TVS before hysterectomy. The histological prevalence of adenomyosis was 44.4% (32/72 patients). In diagnosing adenomyosis, the presence of myometrial cysts was the most specific 2D-TVS feature (specificity, 98%; accuracy, 78%) and heterogeneous myometrium was the most sensitive (sensitivity, 88%; accuracy, 75%). The 3D-TVS markers JZdif ≥ 4 mm and JZ infiltration and distortion had high sensitivity (88%) and the best accuracy (85% and 82%, respectively). For 2D-TVS and 3D-TVS, respectively, the overall accuracy for diagnosis of adenomyosis was 83% and 89%, the sensitivity was 75% and 91%, the specificity was 90% and 88%, the positive predictive value was 86% and 85% and the negative predictive value was 82% and 92%. CONCLUSIONS: The coronal section of the uterus obtained by 3D-TVS permits accurate evaluation and measurement of the JZ, and its alteration has good diagnostic accuracy for adenomyosis.

[Familial ectodermal dysplasia with agenesis of the breasts and the external urethral sphincter. Description of a case]. / Displasia ectodermica familiare con agenesia delle mammelle e dello sfintere uretrale esterno. Descrizione di un caso.

The Authors report a case of athelia and amastia observed in a 28-year-old woman. The association of severe dental alterations, nail dystrophies and irregular cutaneous hyperpigmentation with normal sweating, make it possible to catalogue the anomaly in the hydrotic ectodermal dysplasia, an autosomal dominant hereditary disease. The syndrome, transmitted by the father, is also present in two brothers of the patient: the association of sphincter urethrae agenesis, responsible for urinary incontinence unsuccessful treated with two surgical operations, is to be considered quite fortuitous.

A role for the respiratory therapist in flexible fiberoptic bronchoscopy.

UNLABELLED: All bronchoscopies in our institution are performed by physician-respiratory therapist teams. The therapist instructs the patient, anesthetizes him, does the biopsies, and prepares specimens for laboratory testing. METHODS: We undertook a retrospective study of our performance to evaluate the safety, yield, and cost of this system. RESULTS: Of 216 procedures evaluated, therapist-performed biopsies provided a specific diagnosis in 55%. When a tumor-like mass was seen directly, biopsies were positive 95.7% of the time. No procedure was associated with death. Complications included fever in about 9%, hoarseness in 2%, hemoptysis in 1%, and pneumothorax in one procedure (0.5%). Our institutional costs for flexible fiberoptic bronchoscopy by a physician-respiratory therapist team were only 34% of what they would have been if the same procedures had been performed in the operating room. RESULTS performed were comparable to all others reported in the literature. CONCLUSION: This study clearly demonstrates that respiratory therapists can provide high quality, low cost, safe bronchoscopic assistance to pulmonary internists.

Foreign body aspiration associated with the use of an aerosol inhaler.

A 51-yr-old asthmatic carpenter aspirated a penny using a hand-held, self-pressurized aerosol device. The penny was extracted using a fiberoptic bronchoscope. Because no similar instances are reported in the medical literature, experimental systems were designed to test the likelihood of this event happening with a variety of nebulizers. Nickels , dimes , and pennies were tested for ejection potential and for aspiration likelihood. All inhalers, excepting that designed for Intal, were capable of accommodating dimes and pennies and ejecting them down simulated airways during inspiration. Nickels were accommodated by several inhalers but were not ejected during conventional inspiratory volumes and pressures.