Purpose: To assess the diagnostic accuracy of sonohysterography (SHG) and endometrial sampling during SHG (SHGes) compared to traditional hysteroscopy and biopsy. Methods: Seventy‐two consecutive patients with irregular bleeding and/or intracavitary abnormalities underwent transvaginal sonography (TVS) and SHG. SHG was performed with a 4.7‐mm intrauterine catheter. In all patients, an endometrial biopsy was performed by a syringe vacuum aspiration at the end of SHG. Procedure‐related pain was assessed. Sonographic findings at SHG were defined as normal, focal lesions or diffuse endometrial abnormality. In patients with diffuse endometrial abnormality, hysteroscopy and hysteroscopic guided biopsy were performed. In patients with focal lesions, an operative hysteroscopy was performed. Pathologic report was the gold standard. Results: Mean age was 48 years (interquartile range 38–54). At SHG, no pain, mild, and severe discomfort was reported by 75, 18 and 7% of patients, respectively. Fifty patients underwent hysteroscopic guided biopsy, 22 operative hysteroscopy. Hysteroscopic findings were compared to SHG–SHGes finding. (A) Benign lesions: in 56 cases SHG and SHG sampling was concordant with pathologic report, in five cases SHG and SHG sampling over diagnosed the endometrial lesion. In five cases, simple hyperplasia was missed by SHG endoemetrial sampling. (B) (pre)Malignant lesions (six cases): in five cases SHG–SHGes was correct. One case of adenocarcinoma was intepreted as atypical hyperplasia at SHG–SHGes. Sensitivity, specificity, positive and negative values of SHG and SHGes for intracavitary abnormalities were 100, 64, 94 and 100%, respectively. Conclusions: SHG and SHGes should be considered a reliable office triage in the management of patients with intracavitary uterine abnormalities, as adequate as hysteroscopic endometrial biopsies.
Here we describe a case of an HIV-infected young woman with extensive drug-resistant virus, who was successfully switched from a raltegravir-based regimen to a dolutegravir-based intensified antiretroviral regimen a few days before scheduled caesarean section because of the still detectable viral load. The trough concentrations of all antiretroviral drugs before and after delivery are also described. Our case underlines both the difficult management of young women, HIV-infected at young age with very limited treatment options and the great variability in the pregnancy-related physiological changes affecting the pharmacokinetics of antiretrovirals.
and relate the results to studies on ultrasound diagnosis in view of necessity of surgical intervention. Material and Methods: Two-hundred and thirty-four ovaries of postmenopausal women, who had died from non-gynaecological diseases, were examined prospectively and consecutively, by the pathologist (G.P. Blom), for cystic structures. The results were compared to recent ultrasound studies of adnexal cysts. Results: Ovarian cysts were found in 15.4% of the women. Paraovarian cysts were found in 4.7% of the women. All cysts were benign, except for one woman, who had bilateral serous cystadenoma of borderline type. Macroscopically the borderline cysts were multilocular with mean diameters of 60 mm and 15 mm, respectively. Conclusions:The results were in agreement with diagnostic ultrasound studies. The fact that we found benign ovarian and paraovarian cysts in 21.1% of the women should in our opinion make the gynecologists reconsider the need for surgical intervention in favor of follow-up. OC147Asymptomatic endometrial polyps in postmenopausal women: sonographic surveillance or surgery?
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