RESUMO
OBJECTIVE: Three-dimensional sonography is a good alternative method to assess the position of microinserts. Adequate position after three months allows for the interruption of other contraception. Objective is to evaluate inter-observer reproducibility of the interpretation of coronal transvaginal 3D ultrasound view of the uterus to evaluate the position of Essure®. STUDY DESIGN: Inter-observer reproducibility study. Fifty women underwent successful bilateral placement of microinserts (Essure®) by hysteroscopy in the Department of Gynaecology of a teaching hospital and were included in the study. At three month, 3D ultrasound coronal views of the fifty uterus (accounting for one hundred microinserts) were assessed by five different observers and microinsert position was classified according to the classification described by Legendre et al. Inter-observer reproducibility in reading the 3D coronal view of the uterus was evaluated. RESULTS: The k-value was disparate, from 0.26 to 0.82. Inter-observer reproducibility then ranged from fair to almost perfect, depending on a prior knowledge of the position classification. CONCLUSIONS: Transvaginal 3D coronal view of the uterus is sufficient to assess the positioning of the microinserts when the practionner or the surgeon is familiar with the classification method.
Assuntos
Histeroscopia/métodos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Dispositivos Intrauterinos , Ultrassonografia/métodos , Útero/diagnóstico por imagem , Adulto , Competência Clínica , Tubas Uterinas/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Histerossalpingografia , Interpretação de Imagem Assistida por Computador/métodos , Interpretação de Imagem Assistida por Computador/normas , Imageamento Tridimensional/métodos , Imageamento Tridimensional/normas , Migração de Dispositivo Intrauterino , Dispositivos Intrauterinos/efeitos adversos , Masculino , Implantação de Prótese , Reprodutibilidade dos Testes , Esterilização Tubária/métodos , Cirurgiões/normas , Útero/patologiaRESUMO
Since the Women's health Initiative (WHI) study published in 2002, hormonal replacement therapy (HRT) prescription is discussed, especially concerning the risk of cancer, and breast cancer in particular. This calling into question led France to publish in 2004 ANAES and AFFAPS recommendations. From recent literature data published by the EMAS, the North American Society and CNGOF, this study aim to discuss cancer risk under HRT. The relative risk (RR) of breast cancer varies from 1.26 in the WHI study to 1.66 in the Million Women Study, with different results according to the interval between menopause and starting hormone therapy and the modalities of HRT (different data for estrogen-only hormone therapy, or within the type of progestogen used). However, impact of breast cancer decreases since 2004, in which role of HRT is difficult to specify. Part of HRT in ovarian cancer is controversial, data being discordant in recent studies and mainly involving estrogen-only hormone therapy. Regarding protective property in endometrial cancer, the dose and duration of progestogen therapy seem to be the main factors. At last, there is no evidence as regards the role of HRT in drop of colon cancer incidence or increased mortality by pulmonary cancer. These updates data must be part of patient information before introducing HRT, in order to get the best evaluation of individual risk and benefit of this treatment.
