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1.
Int J Gynecol Cancer ; 20(5): 781-6, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20973268

RESUMEN

INTRODUCTION: The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group. METHODS: The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral. RESULTS: Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P = 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status. CONCLUSIONS: The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.


Asunto(s)
Neoplasias Ováricas/diagnóstico por imagen , Ovario/irrigación sanguínea , Ovario/diagnóstico por imagen , Ultrasonografía Doppler en Color/métodos , Enfermedades de los Anexos/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/irrigación sanguínea , Neoplasias Ováricas/patología , Estudios Prospectivos , Vagina , Adulto Joven
2.
Eur J Obstet Gynecol Reprod Biol ; 153(2): 185-7, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20702018

RESUMEN

OBJECTIVE: The sentinel node is defined as the first lymph node in a regional basin that receives lymph flow from the primary tumor. There is still a controversy over deep versus superficial injection administration in the breast. STUDY DESIGN: From June 2006 to June 2008, 133 patients with biopsy proven breast carcinoma and clinically negative axilla have been treated with conservative surgery and a study of their axillary sentinel lymph nodes (SLN) has been conducted. RESULTS: The median number of SLN detected was significantly higher in the periareolarly injected (PA) group (2.43) than in the intratumorally injected (IT) group (1.92) (p=0.008). The incidence of positive SLN in the PA group was not significantly different from the incidence observed in the IT group (p=0.22). CONCLUSION: Both techniques seem to reliably identify the true SLN in the axilla. Although intradermal as compared with intratumoral injection has numerous advantages, including ease of injection, shorter time between injection and sentinel node identification, and increased radiotracer nodal uptake, nevertheless, intradermal injection allows almost exclusive identification of axillary nodes, and only on rare occasions, of non-axillary nodes. We therefore think that intratumoral injection must be preferred to intradermal when possible to identify the node that is the first draining step of the tumoral tissue.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Radiofármacos/administración & dosificación , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Anciano , Axila/diagnóstico por imagen , Mama/diagnóstico por imagen , Femenino , Humanos , Inyecciones Intralesiones , Ganglios Linfáticos/diagnóstico por imagen , Persona de Mediana Edad , Cintigrafía
3.
Rev Med Univ Navarra ; 53(2): 3, 2009.
Artículo en Español | MEDLINE | ID: mdl-19994761
4.
Int Arch Med ; 2(1): 11, 2009 Apr 22.
Artículo en Inglés | MEDLINE | ID: mdl-19386113

RESUMEN

BACKGROUND: The aim of this paper is to review and compare the results obtained using the Pfannenstiel, laparoscopy and minilaparotomy approaches for total hysterectomy procedure in relation to benign uterine diseases. METHODS: A retrospective data analysis was performed on 165 patients who underwent hysterectomy for benign uterine diseases at our centre during the period 2004 to 2006. FINDINGS: The minilaparotomy procedure was the fastest procedure with a mean time of 73.4 minutes (range: 67.85 to 78.94 minutes, p < 0.001). Hospital stay was shortest for laparosopic procedure (mean time: 3.24 days, range: 2.86 to 3.61 days) (p < 0.001). The rate of intraoperative and postoperative complications were not statistical different among three procedures. CONCLUSION: The minilaparotomy procedure offers a minimally invasive option for total hysterectomy due to benign uterine disease.

6.
J Womens Health (Larchmt) ; 17(5): 777-82, 2008 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-18479230

RESUMEN

OBJECTIVE: The aim of this investigation was to assess whether a correlation exists among microvascular density (MVD), expression of endothelial growth factor, and pelvic pain in patients with ovarian endometriosis. METHODS: Sixty-five patients (mean age 33.3 years, range 20-49 years) were diagnosed as having suspected cystic ovarian endometriosis and were scheduled for surgery. Patients were classified into two groups according to clinical complaints: group A, asymptomatic patients or patients with mild dysmenorrhea, and group B patients with severe dysmenorrhea and/or chronic pelvic pain and/or dispareunia. Immunohistochemical staining for CD34 and vascular endothelial growth factor (VEGF) in histological specimens for MVD and VEGF cellular expression assessment were performed. RESULTS: Five patients were excluded after surgery because no ovarian endometriosis was found in histological analysis. Thirty women were included in each group. MVD was higher in the symptomatic group. No differences were found in VEGF cellular expression. CONCLUSIONS: We conclude that pain symptoms in ovarian endometriosis are directly correlated with MVD but not with VEGF cellular expression. Based on our results, it appears that in endometriotic cysts, the angiogenic processes are present but not completely mediated by VEGF.


Asunto(s)
Endometriosis/sangre , Microcirculación/patología , Neovascularización Patológica/metabolismo , Quistes Ováricos/irrigación sanguínea , Factor A de Crecimiento Endotelial Vascular/sangre , Adulto , Velocidad del Flujo Sanguíneo , Dismenorrea/etiología , Endometriosis/complicaciones , Endometriosis/patología , Femenino , Humanos , Inmunohistoquímica , Laparoscopía , Persona de Mediana Edad , Quistes Ováricos/complicaciones , Dolor Pélvico/etiología
7.
J Med Case Rep ; 2: 105, 2008 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-18400095

RESUMEN

INTRODUCTION: Postpartum ovarian vein thrombosis is an uncommon complication; incidence varies between 0.002% and 0.05%. It most often occurs during the 2-15 days following delivery. CASE PRESENTATION: A 22-year-old pregnant woman at term presented to hospital with uterine contractions, abdominal pain, nausea and vomiting. After delivery an ovarian vein thrombosis was diagnosed. CONCLUSION: Low-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis.

9.
J Ultrasound Med ; 26(8): 1007-11, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17646362

RESUMEN

OBJECTIVE: The purpose of this study was to assess the reproducibility of 3-dimensional (3D) sonography for classifying adnexal masses. METHODS: Eighty-two consecutive women with the diagnosis of an adnexal mass on 2-dimensional transvaginal sonography were reevaluated by 3D sonography, and 3D volume data from each mass were stored. Two different examiners (6 years and 1 year of experience in 3D sonography, respectively) reviewed 3D sonograms 1 month after the last patient was recruited and then 1 week later again. Masses had to be classified as benign or malignant. Criteria suggestive of malignancy were the presence of a thick wall, gross papillary projections, solid areas, and solid echogenicity. A definitive histologic diagnosis was obtained in every case. Intraobserver and interobserver agreement was estimated by calculating the Cohen kappa index. RESULTS: Twenty-seven (33%) tumors were malignant, and 55 (67%) were benign. Intraobserver agreement for both examiners was good (kappa = 0.78 and 0.72, respectively). Interobserver agreement was also good (kappa = 0.70). CONCLUSIONS: Three-dimensional sonography is a reproducible technique for morphologic assessment of adnexal masses.


Asunto(s)
Enfermedades de los Anexos/diagnóstico por imagen , Imagenología Tridimensional , Enfermedades de los Anexos/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ultrasonografía
10.
Fertil Steril ; 87(6): 1271-6, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17336965

RESUMEN

OBJECTIVE: To assess whether a correlation exists between angiogenesis in ovarian endometrioma with the presence of pelvic pain. DESIGN: Prospective study. SETTING: Tertiary-care university hospital. PATIENT(S): Sixty-five patients (mean age, 33.3 years; range, 20-49 years) were diagnosed as having suspected cystic ovarian endometriosis, and were scheduled for surgery. Patients were classified into two groups according to clinical complaints: group A, asymptomatic patients or patients presenting mild dysmenorrhea; and group B, severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia. INTERVENTION(S): Transvaginal power-Doppler ultrasonography and immunohistochemical staining for CD-34 in histological specimens. MAIN OUTCOME MEASURE(S): The amount of blood flow, lowest pulsatility and resistance indexes, and microvessel density (MVD). RESULT(S): Five patients were excluded after surgery because no ovarian endometriosis was found in histological analysis. Thirty women were included in each group. Ovarian endometriomas were more frequently vascularized in group B (87%) than in group A (60%). The lowest pulsatility and resistance indexes were significantly lower, and MVD was significantly higher, in group B compared with group A. There was a correlation between the degree of vascularization detected by power-Doppler ultrasound and MVD. CONCLUSION(S): We conclude that vascularization of ovarian endometriomas evaluated by transvaginal color Doppler and MVD is higher in patients who present with pelvic pain than in asymptomatic patients. This could be an indicator of the activity of endometriosis.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Endometriosis/diagnóstico por imagen , Endometriosis/fisiopatología , Endometrio/irrigación sanguínea , Endometrio/diagnóstico por imagen , Enfermedades del Ovario/fisiopatología , Dolor Pélvico/etiología , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Laparoscopía , Enfermedades del Ovario/diagnóstico por imagen , Enfermedades del Ovario/patología , Enfermedades del Ovario/cirugía , Estudios Prospectivos , Ultrasonografía Doppler
11.
Fertil Steril ; 88(2): 513-5, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17296185

RESUMEN

Vascular endothelial growth factor (VEGF) serum levels and VEGF and cellular expression were prospectively analyzed in 60 patients (group A consisted of asymptomatic patients or patients presenting mild dysmenorrhea; 30 women comprised group B severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists among VEGF serum levels, VEGF cellular expression, and pelvic pain. No differences were found in VEGF serum levels and VEGF cellular expression between both groups. Therefore, we conclude that pain symptoms in ovarian endometriosis are not correlated with VEGF serum levels and VEGF cellular expression.


Asunto(s)
Endometriosis/sangre , Endometriosis/complicaciones , Enfermedades del Ovario/sangre , Enfermedades del Ovario/complicaciones , Dolor Pélvico/etiología , Factor A de Crecimiento Endotelial Vascular/sangre , Factor A de Crecimiento Endotelial Vascular/metabolismo , Adulto , Endometriosis/metabolismo , Femenino , Humanos , Quistes Ováricos/metabolismo , Enfermedades del Ovario/metabolismo , Dolor Pélvico/sangre , Dolor Pélvico/metabolismo , Estudios Prospectivos , Distribución Tisular
12.
Clin Breast Cancer ; 6(6): 533-4, 2006 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-16595038

RESUMEN

We report the case of a 35-year-old pregnant woman with inflammatory breast carcinoma initially treated with 5-fluorouracil/doxorubicin/cyclophosphamide beginning her 13th week of pregnancy. There was no noticeable shrinkage of the axillary or breast tumors after 4 cycles, at which point the patient accepted a treatment change to docetaxel. Four cycles of docetaxel at 100 mg/m2 every 21 days were delivered from the 25th week of pregnancy with good tolerance. She exhibited a clinical complete response, determined by clinical examination and imaging tests. Obstetric monitoring with fetal ultrasound showed normal fetal development throughout chemotherapy. After delivery of a healthy child, she underwent surgery, which showed tumor downstaging to pT0 N2, followed by radiation therapy and hormone therapy. This report suggests the safety of docetaxel after the first trimester of pregnancy.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma/tratamiento farmacológico , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Adulto , Neoplasias de la Mama/patología , Carcinoma/patología , Ciclofosfamida/administración & dosificación , Docetaxel , Doxorrubicina/administración & dosificación , Femenino , Desarrollo Fetal , Fluorouracilo/administración & dosificación , Humanos , Inflamación , Embarazo , Complicaciones Neoplásicas del Embarazo/patología , Resultado del Embarazo , Primer Trimestre del Embarazo , Taxoides/administración & dosificación
13.
J Ultrasound Med ; 24(5): 689-96, 2005 May.
Artículo en Inglés | MEDLINE | ID: mdl-15840800

RESUMEN

OBJECTIVE: The purpose of this study was to explore the role of a new concept ("vascular sampling") as a third step to discriminate benign and malignant lesions in B-mode and color Doppler sonographically suggestive adnexal masses. METHODS: Forty-five women (mean age, 52.3 years; range, 17-82 years) with the diagnosis of complex adnexal masses on B-mode sonography were evaluated using 3-dimensional power Doppler sonography. Four women had bilateral masses. After a morphologic reevaluation was done, color pulsed Doppler sonography was used to obtain flow velocity waveforms, and velocimetric indices were calculated (resistive index, pulsatility index, and peak systolic velocity). Thereafter, 3-dimensional power Doppler sonography was used to assess vascularization of highly suggestive areas (gross papillary projections, solid areas, and thick septations), meaning a focused assessment ("sampling") of a suggestive area of the tumor. With a virtual organ computer-aided analysis program, vascular indices (vascularization index, flow index, and vascular flow index) were automatically calculated. A definitive histologic diagnosis was obtained in each case. RESULTS: Forty masses (82%) were malignant and 9 (18%) were benign. Morphologic evaluation revealed 10 (20%) unilocular solid masses, 20 (41%) multilocular solid masses, and 19 (39%) mostly solid masses. Blood flow was found in all cases. Median vascularization index (15.5% versus 8.2%; P = .002), flow index (33.6 versus 20.8; P = .007), and vascular flow index (5.2 versus 2.3; P = .001) were significantly higher in malignant tumors. No differences were found in resistive index (0.43 versus 0.45; P = .770), pulsatility index (0.62 versus 0.65; P = .694), and peak systolic velocity (15.6 versus 12 cm/s; P = .162). CONCLUSIONS: Three-dimensional power Doppler vascular sampling seems to be a promising tool for predicting ovarian cancer in vascularized complex adnexal masses. It could be better than conventional color pulsed Doppler imaging.


Asunto(s)
Anexos Uterinos/irrigación sanguínea , Enfermedades de los Anexos/diagnóstico por imagen , Enfermedades de los Anexos/fisiopatología , Imagenología Tridimensional , Neoplasias Ováricas/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Anexos Uterinos/diagnóstico por imagen , Anexos Uterinos/patología , Enfermedades de los Anexos/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Humanos , Persona de Mediana Edad , Variaciones Dependientes del Observador , Neoplasias Ováricas/complicaciones , Valor Predictivo de las Pruebas , Estudios Retrospectivos
14.
J Ultrasound Med ; 23(6): 743-8, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15244297

RESUMEN

OBJECTIVE: To compare the diagnostic performance of transvaginal color Doppler sonography (TVCD) and sonohysterography (SHG) in the diagnosis of endometrial polyps. METHODS: Fifty-one women (mean age, 51 years; range, 27-75 years) with clinical or B-mode sonographic suspicion of endometrial polyps were included in this prospective study. Transvaginal color Doppler sonography first and then SHG were performed in all patients. On TVCD, a polyp was suspected when a vascular pedicle penetrating the endometrium from the myometrium was identified. On SHG, a polyp was suspected when a focal polypoid lesion was seen within the endometrial cavity. All patients underwent hysteroscopy and endometrial biopsy, the findings of which were used as the criterion standard. Sensitivity and specificity for TVCD and SHG were calculated and compared by the McNemar test. RESULTS: Hysteroscopy and endometrial biopsy findings were as follows: endometrial polyps, 41; endometrial hyperplasia, 3; cystic atrophy, 4; proliferative endometrium, 2; and endometritis, 1. Sensitivity and specificity for TVCD and SHG were 95% and 80% and 100% and 80%, respectively (McNemar test, P = .5) CONCLUSIONS: Transvaginal color Doppler sonography and SHG had similar performance for diagnosing endometrial polyps.


Asunto(s)
Neoplasias Endometriales/diagnóstico por imagen , Endosonografía , Pólipos/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Anciano , Endometrio/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
15.
J Ultrasound Med ; 22(3): 243-7, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12636323

RESUMEN

OBJECTIVE: To compare gray scale and color Doppler features of primary and metastatic ovarian carcinomas. METHODS: Clinical, sonographic (gray scale and color Doppler), and histopathologic data of 143 patients with primary (n = 127 adnexal masses) and metastatic (n = 34 adnexal masses) ovarian cancer were reviewed. Morphologic gray scale parameters assessed were bilaterality, tumor volume, echogenicity, and presence of septa, papillary projections, or solid areas. Color Doppler parameters were presence of blood flow, tumor blood flow location (central versus peripheral), subjective impression of blood flow amount (scanty, moderate, or abundant), lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity (centimeters per second). RESULTS: No statistical differences were found in bilaterality, tumor volume, presence of septa, papillary projections or solid areas, presence of blood flow, tumor blood flow location, subjective impression of blood flow amount, lowest resistive index, lowest pulsatility index, and maximal peak systolic velocity. Metastatic carcinomas were more frequently purely solid tumors (47% versus 26%; P = .001; likelihood ratio, 2.4; 95% confidence interval, 1.2-4.7). CONCLUSIONS: The presence of a purely solid tumor indicates a higher probability of metastatic carcinoma than primary ovarian cancer. However, with the use of gray scale and color Doppler sonography, it is difficult to differentiate primary ovarian carcinomas from metastatic tumors to the ovary.


Asunto(s)
Cistadenocarcinoma Seroso/diagnóstico , Cistadenocarcinoma Seroso/secundario , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/secundario , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/secundario , Ovario/diagnóstico por imagen , Ultrasonografía Doppler en Color , Vagina/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo/fisiología , Cistadenocarcinoma Seroso/fisiopatología , Femenino , Humanos , Menopausia/fisiología , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Secundarias/fisiopatología , Neoplasias Ováricas/fisiopatología , Ovario/irrigación sanguínea , Ovario/patología , Flujo Sanguíneo Regional/fisiología , Estudios Retrospectivos , España , Vagina/irrigación sanguínea , Vagina/patología , Salud de la Mujer
16.
J Ultrasound Med ; 22(3): 249-54, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12636324

RESUMEN

OBJECTIVE: To evaluate the role of three-dimensional transvaginal sonography in assessing complex adnexal masses. METHODS: Forty-one women (mean age, 49.5 years; range, 23-75 years) with the diagnosis of complex adnexal masses on the basis of two-dimensional transvaginal sonography were reevaluated by three-dimensional transvaginal sonography. Two different sonologists evaluated the two- and three-dimensional transvaginal sonograms. Criteria indicative of malignancy included the presence of gross papillary projections, solid areas, and solid echogenicity for both techniques. Three women (7%) had bilateral masses, giving a total of 44 masses that were ultimately assessed. A definitive histologic diagnosis was obtained in every case after surgical tumor removal. RESULTS: Twenty-one tumors (47.7%) were proved malignant, and 23 (52.3%) were benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for two- and three-dimensional transvaginal sonography were 90%, 61%, 68%, 87%, and 75% and 100%, 78%, 81%, 100%, and 89%, respectively. There were no statistical differences between two- and three-dimensional transvaginal sonography (McNemar test, P = .687). The agreement between both examiners was high (kappa index = 0.71). CONCLUSIONS: The use of three-dimensional transvaginal sonography does not significantly improve the two-dimensional transvaginal sonographic morphologic assessment of complex adnexal masses; however, we found it useful for reinforcing initial diagnostic impressions.


Asunto(s)
Anexos Uterinos/diagnóstico por imagen , Anexos Uterinos/patología , Enfermedades de los Anexos/diagnóstico , Enfermedades de los Anexos/patología , Imagenología Tridimensional , Ultrasonografía Intervencional , Adenofibroma/diagnóstico , Adenofibroma/patología , Adulto , Anciano , Reacciones Falso Negativas , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico , Neoplasias Ováricas/patología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Salud de la Mujer
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