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Muacevic A, Adler JR, Aydın A, Yalcin Bahat P, Akça A. Effects of Dienogest Therapy on Endometriosis-Related Dysmenorrhea, Dyspareunia, and Endometrioma Size. Cureus 2023; 15:e34162. [PMID: 36843832 PMCID: PMC9949989 DOI: 10.7759/cureus.34162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Endometriosis is an estrogen-dependent chronic inflammatory disease that is defined by the presence of endometrial-like tissue outside of the uterus. The most common localization is the ovaries, and endometriosis in this location is then called an endometrioma. According to the European Society of Human Reproduction and Embryology (ESHRE) (2022) guidelines, the most commonly prescribed treatments for endometriosis include drugs that alter the hormonal milieu. Dienogest is a new generation of progestin used in the treatment of endometriosis. The aim of this study was to assess the effect of Dienogest treatment on endometrioma size and endometriosis-related pain symptoms over a six-month follow-up period. METHODS This prospective observational study was conducted at a tertiary clinic in Turkey between March 2020 and March 2021. Here, 64 patients aged 17-49 years with unilateral or bilateral endometriomas without any hormone-dependent cancers and any medical conditions contraindicating the onset of hormonal treatment, such as active venous thromboembolism, previous or current cardiovascular disease, diabetes with cardiovascular complications, current severe liver disease, and not being pregnant, were included. Endometrioma sizes were determined by transvaginal ultrasonography (TVUS). Dysmenorrhea and dyspareunia symptoms were evaluated using the visual analogue scale (VAS). Patients received Dienogest 2 mg/day continuously for six months. At the three- and six-month follow-ups, the patients were re-evaluated. RESULTS The mean endometrioma size decreased significantly from an initial measurement of 44.0 ± 13 mm to 39.5 ± 15 mm at three months and to 34.4 ± 18 mm at the six-month follow-up. The mean dysmenorrhea VAS scores before treatment, at the three-month follow-up, and at the six-month follow-up were 6.9 ± 2.6, 4.3 ± 2.8, and 3.8 ± 2.7, respectively. Dysmenorrhea VAS scores decreased significantly over the first three months (p<0.01). Similarly, the mean VAS score for dyspareunia decreased at three and six months compared with the pretreatment value (p<0.01). CONCLUSION This study shows that dienogest treatment reduced the symptoms of dysmenorrhea and dyspareunia and the size of endometriomas. However, the main significant decrease in dysmenorrhea and dyspareunia symptoms was noted in the first three months, making it a good treatment option, especially in young patients with a fertility wish.
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Güler MC, Tanyeli A, Erdoğan DG, Eraslan E, Çomaklı S, Polat E, Doğanay S. Urapidil alleviates ovarian torsion detorsion injury via regulating oxidative stress, apoptosis, autophagia, and inflammation. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:935-942. [PMID: 34712424 PMCID: PMC8528257 DOI: 10.22038/ijbms.2021.57196.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/22/2021] [Indexed: 01/10/2023]
Abstract
Objective(s): This study aimed to determine anti-inflammatory, antioxidant, and antiapoptotic properties of urapidil (Ura) against ovarian torsion detorsion (T/D) injury in rats. Materials and Methods: 40 female Wistar albino rats were grouped as sham, T/D, T/D+dimethyl sulfoxide (DMSO), T/D+Urapidil (Ura) 0.5 mg/kg (low dose), and T/D+Urapidil (Ura) 5 mg/kg (high dose) groups. In treatment groups, Ura was administered intraperitoneally just before detorsion. Biochemical parameters (TAS, TOS, MDA, MPO, and SOD) and immunohistochemical (IL-1β, TNF-α, NF-κB, LC3B, and Caspase-3) analyzes were performed. Results: In the T/D group, OSI and MPO levels were elevated significantly while TAS values decreased compared with the sham group. A significant difference occurred in the low dose treatment group in TAS and OSI levels compared with the T/D group. In the high dose treatment group, significant elevation in TAS but reduction in OSI and MDA levels were observed compared with the T/D group. Immunohistochemical staining resulted in IL-1β, TNF-α, NF-κB, LC3B, and caspase-3 immunopositivity in the T/D group, while Ura treatment decreased those parameters. Intensive congestion and hemorrhage were observed in the T/D group, but contrary to this, treatment groups had alleviated congestion and hemorrhage. Conclusion: These results suggest that Ura demonstrated protective effects against ovarian T/D injury via anti-oxidative, anti-inflammatory, and anti-apoptotic features.
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Affiliation(s)
- Mustafa Can Güler
- Department of Physiology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Ayhan Tanyeli
- Department of Physiology, Atatürk University, Faculty of Medicine, Erzurum, Turkey
| | - Derya Güzel Erdoğan
- Department of Physiology, Sakarya University, Faculty of Medicine, Sakarya, Turkey
| | - Ersen Eraslan
- Department of Physiology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - Selim Çomaklı
- Department of Pathology, Atatürk University, Veterinary Faculty, Erzurum, Turkey
| | - Elif Polat
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erzurum Technical University, Erzurum, Turkey
| | - Songül Doğanay
- Department of Physiology, Sakarya University, Faculty of Medicine, Sakarya, Turkey
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Abstract
BACKGROUND Acute pelvic pain in women may be due to gynecological, gastrointestinal, and urinary tract disorders. Ectopic pregnancy (EP), pelvic inflammatory disease (PID), and ruptured ovarian cysts are the most common gynecological causes for acute pelvic pain and their diagnosis can be challenging. METHODS Patient history, clinical examination, and blood tests as well as patient age and potential pregnancy status help to establish the correct diagnosis. While sonography (US) remains the primary imaging modality of choice, computed tomography (CT) plays an important role in patients with indeterminate US evaluation and for treatment planning. CONCLUSION Diagnostic imaging is pivotal to differentiate potentially life- and fertility-threatening conditions from those that can be treated conservatively. Profound knowledge of the most common gynecological pathologies allows prompt and correct radiological diagnosis and assists in proper treatment planning.
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Phillips CH, Wortman JR, Ginsburg ES, Sodickson AD, Doubilet PM, Khurana B. First-trimester emergencies: a radiologist's perspective. Emerg Radiol 2017; 25:61-72. [PMID: 28948411 DOI: 10.1007/s10140-017-1556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/13/2017] [Indexed: 12/27/2022]
Abstract
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.
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Affiliation(s)
- Catherine H Phillips
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jeremy R Wortman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Elizabeth S Ginsburg
- Department of Infertility and Reproductive Surgery, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Peter M Doubilet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Naffaa L, Deshmukh T, Tumu S, Johnson C, Boyd KP, Meyers AB. Imaging of Acute Pelvic Pain in Girls: Ovarian Torsion and Beyond ☆. Curr Probl Diagn Radiol 2017; 46:317-329. [DOI: 10.1067/j.cpradiol.2016.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
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Laganà AS, Sofo V, Salmeri FM, Palmara VI, Triolo O, Terzić MM, Patrelli TS, Lukanovic A, Bokal EV, Santoro G. Oxidative Stress during Ovarian Torsion in Pediatric and Adolescent Patients: Changing The Perspective of The Disease. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2015; 9:416-23. [PMID: 26985329 PMCID: PMC4793162 DOI: 10.22074/ijfs.2015.4598] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 09/01/2015] [Indexed: 12/20/2022]
Abstract
Among the different causes of gynecological acute pelvic pain, ovarian torsion represents a surgical emergency. It is a rare case in the pediatric/adolescent aged group
that must be included in the differential diagnosis of any girl with abdominal pain or
pelvic/abdominal mass. Current recommendations suggest that laparoscopic detorsion should be performed in order to preserve the integrity of the ovaries and fertility,
although oophoropexy may be considered in case of severe necrosis. Nevertheless,
maintaining the circulation of the ovary after detorsion deteriorates the tissue injury
and leads to a pathologic process called ischaemia/reperfusion (I/R) injury, which is
characterized by oxidative stress. During the detorsion process, an excess amount of
molecular oxygen is supplied to the tissues, and reactive species of oxygen (ROS)
such as superoxide radical (O2-), hydrogen peroxide (H2O2), hydroxyl radical (OH•),
as well as reactive nitrogen species (RNS) are produced in excess. ROS, RNS and
their toxic products cause DNA damage and lipid peroxidation in the cellular and
mitochondrial membranes, leading to cell death. In spite of attention on this topic,
currently there is no shared and clear evidence about the use of anti-inflammatory
and antioxidant agents to prevent I/R damage after laparoscopic ovarian detorsion.
Considering this element, future research should aim to develop shared protocols for
the clinical use (route of application, dosage and time of application) of antioxidants
after laparoscopic management of this condition.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Vincenza Sofo
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Francesca Maria Salmeri
- Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Vittorio Italo Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Onofrio Triolo
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood, G. Barresi, University of Messina, Messina, Italy
| | - Milan Milosav Terzić
- University of Belgrade, School of Medicine, Belgrade, Serbia; Clinic for Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Adolf Lukanovic
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Eda Vrtcnik Bokal
- Department of Gynecology and Obstetrics, University Clinical Center, Ljubljana, Slovenia
| | - Giuseppe Santoro
- Department of Biomedical Sciences and Morpho-Functional Images, University of Messina, Messina, Italy
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Abstract
Clinical symptoms and signs of ovarian torsion are often nonspecific, and imaging studies have a crucial role in making an accurate timely diagnosis. Ultrasound with color Doppler is often the initial investigation. However, as illustrated in our case, a normal Doppler study cannot exclude the diagnosis of ovarian torsion, and MRI should be performed if a high degree of concern for ovarian torsion persists. We report a case of a case of an 18-year-old female who was diagnosed with ovarian torsion on MRI. To the best of our knowledge, "whirlpool sign on MRI" has not been reported previously. If this sign is present, a specific diagnosis of ovarian torsion can be made.
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Revisiting the role of MRI in gynecological emergencies – An institutional experience. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
ABSTRACTOvarian torsion is an uncommon gynecological emergency that requires prompt recognition and treatment. It may present with nonspecific signs and symptoms, and should be considered in any female with acute abdominal pain. The diagnosis is based on an awareness of the relevant risk factors, the clinical presentation, and a high index of suspicion. Timely investigation and management can make the difference between ovarian loss and salvage — an outcome of great importance in the population of reproductive age females.
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Affiliation(s)
- Chris Martin
- Faculty of Medicine, University of Western Ontario, London, Ont
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Chukus A, Tirada N, Restrepo R, Reddy NI. Uncommon Implantation Sites of Ectopic Pregnancy: Thinking beyond the Complex Adnexal Mass. Radiographics 2015; 35:946-59. [PMID: 25860721 DOI: 10.1148/rg.2015140202] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Uncommon implantation sites of ectopic pregnancy include the cervix, interstitial segment of the fallopian tube, scar from a prior cesarean delivery, uterine myometrium, ovary, and peritoneal cavity. Heterotopic and twin ectopic pregnancies are other rare manifestations. Ultrasonography (US) plays a central role in diagnosis of uncommon ectopic pregnancies. US features of an interstitial ectopic pregnancy include an echogenic interstitial line and abnormal bulging of the myometrial contour. A gestational sac that is located below the internal os of the cervix and that contains an embryo with a fetal heartbeat is indicative of a cervical ectopic pregnancy. In a cesarean scar ectopic pregnancy, the gestational sac is implanted in the anterior lower uterine segment at the site of the cesarean scar, with thinning of the myometrium seen anterior to the gestational sac. An intramural gestational sac implants in the uterine myometrium, separate from the uterine cavity and fallopian tubes. In an ovarian ectopic pregnancy, a gestational sac with a thick hyperechoic circumferential rim is located in or on the ovarian parenchyma. An intraperitoneal gestational sac is present in an abdominal ectopic pregnancy. Intra- and extrauterine gestational sacs are seen in a heterotopic pregnancy. Two adnexal heartbeats suggest a live twin ectopic pregnancy. Recognition of the specific US features will help radiologists diagnose these uncommon types of ectopic pregnancy.
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Affiliation(s)
- Anjeza Chukus
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140 (A.C., N.I.R.); Department of Radiology, George Washington University School of Medicine, Washington, DC (N.T.); and Department of Radiology, Miami Children's Hospital, Miami, Fla (R.R.)
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12
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Al-Shukri M, Mathew M, Al-Ghafri W, Al-Kalbani M, Al-Kharusi L, Gowri V. A clinicopathological study of women with adnexal masses presenting with acute symptoms. Ann Med Health Sci Res 2014; 4:286-8. [PMID: 24761256 PMCID: PMC3991958 DOI: 10.4103/2141-9248.129067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Abdominal pain is one of the most common presentations of adnexal pathology in gynecology. Early diagnosis and intervention is essential especially in adolescent girls and reproductive age group women to conserve reproductive function. Aim: The purpose of the following study is to assess the clinicopathologic outcome of women with adnexal masses presenting with acute pain. Subjects and Methods: A retrospective study of women with adnexal masses who had surgical intervention for acute symptoms from June 2007 to May 2012 was undertaken. During the study period, a total of 57 women were operated for adnexal masses as emergency. Results: Of the 57 women operated for adnexal masses as emergency, the most common pathology was teratoma 26% (15/57) followed by corpus luteal hemorrhage (16%) and endometriosis (14%). Laparoscopy was the initial surgical approach in just over 50% of patients, but surgery was completed laparoscopically only in about one-third of patients. Conservative surgery in the form of ovarian cystectomy was possible in 70% of patients. Conclusion: Complications of adnexal masses such as torsion and hemorrhage are common causes of acute abdominal pain. Timely diagnosis of the adnexal pathology and surgical intervention will help to preserve the reproductive outcome. Conservative surgery was possible in 70% of our study group.
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Affiliation(s)
- M Al-Shukri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - M Mathew
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - W Al-Ghafri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - M Al-Kalbani
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - L Al-Kharusi
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - V Gowri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Masselli G, Brunelli R, Monti R, Guida M, Laghi F, Casciani E, Polettini E, Gualdi G. Imaging for acute pelvic pain in pregnancy. Insights Imaging 2014; 5:165-81. [PMID: 24535757 PMCID: PMC3999369 DOI: 10.1007/s13244-014-0314-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/08/2014] [Accepted: 01/21/2014] [Indexed: 12/20/2022] Open
Abstract
Acute pelvic pain in pregnancy presents diagnostic and therapeutic challenges. Standard imaging techniques need to be adapted to reduce harm to the foetus from X-rays because of their teratogenic and carcinogenic potential. Ultrasound remains the primary imaging investigation of the pregnant abdomen. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of gynaecological and obstetric problems during pregnancy and in the setting of acute abdomen during pregnancy. MRI overcomes some of the limitations of ultrasound, mainly the size of the gravid uterus. MRI poses theoretical risks to the foetus and care must be taken to minimise these with the avoidance of contrast agents. Teaching Points • Ultrasound and MRI are the preferred investigations for acute pelvic pain during pregnancy. • Ultrasound remains the primary imaging investigation because of availability and portability. • MRI helps differentiate causes of acute pelvic pain when ultrasound is inconclusive.
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Affiliation(s)
- Gabriele Masselli
- Umberto I Hospital, Radiology Department, Sapienza University, Viale del Policlinico 155, 00161, Rome, Italy,
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Masselli G, Derchi L, McHugo J, Rockall A, Vock P, Weston M, Spencer J. Acute abdominal and pelvic pain in pregnancy: ESUR recommendations. Eur Radiol 2013; 23:3485-500. [DOI: 10.1007/s00330-013-2987-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/10/2013] [Accepted: 07/13/2013] [Indexed: 12/19/2022]
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Abstract
PURPOSE Ectopic pregnancy (EP) presents a major health problem for women of child-bearing age. EP refers to the pregnancy occurring outside the uterine cavity that constitutes 1.2-1.4 % of all reported pregnancies. All identified risk factors are maternal: pelvic inflammatory disease, Chlamydia trachomatis infection, smoking, tubal surgery, induced conception cycle, and endometriosis. These developments have provided the atmosphere for trials using methotrexate as a non-surgical treatment for EP. The diagnosis measure of EP is serum human chorionic gonadotropin, urinary hCGRP/i-hCG, progesterone measurement, transvaginal ultrasound scan, computed tomography, vascular endothelial growth factor, CK, disintegrin and metalloprotease-12 and hysterosalpingography. The treatment option of EP involves surgical treatment by laparotomy or laparoscopy, medical treatment is usually systemic or through local route, or by expectant treatment. RESULTS It was concluded that review data reflect a decrease in surgical treatment and not an actual decline in EP occurrence so that further new avenues are needed to explore early detection of the EP.
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Lewiss RE, Saul T, Goldflam K. Sonographic cervical motion tenderness: A sign found in a patient with pelvic inflammatory disease. Crit Ultrasound J 2012; 4:20. [PMID: 22989255 PMCID: PMC3480933 DOI: 10.1186/2036-7902-4-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/18/2012] [Indexed: 11/10/2022] Open
Abstract
No single historical, physical, laboratory, or imaging finding is both sensitive and specific for the diagnosis of pelvic inflammatory disease (PID). Cervical motion tenderness (CMT), when present, is classically found on bimanual examination of the cervix and uterus. CMT is often associated with PID but can be present in other disease entities. We present a case report of a patient who was ultimately diagnosed with acute PID. The evaluating physician performed a trans-vaginal bedside ultrasound, and the operator appreciated 'sonographic CMT'. In cases where the physical examination is equivocal or in patients where the exact location of tenderness is difficult to discern, performing a trans-vaginal bedside ultrasound examination can increase the physician's confidence that CMT is present as the cervix is being directly visualized as pressure is applied with the probe. Bedside ultrasound and specifically sonographic CMT may prove useful in diagnosing PID in patients with equivocal or unclear physical examination findings.
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Affiliation(s)
- Resa E Lewiss
- Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY, 10025, USA
| | - Turandot Saul
- Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY, 10025, USA
| | - Katja Goldflam
- Department of Emergency Medicine, Yale-New Haven Hospital, 464 Congress Avenue, Suite 260, New Haven, CT, 06519, USA
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Roche O, Chavan N, Aquilina J, Rockall A. Radiological appearances of gynaecological emergencies. Insights Imaging 2012; 3:265-75. [PMID: 22696088 PMCID: PMC3369119 DOI: 10.1007/s13244-012-0157-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/26/2012] [Accepted: 02/21/2012] [Indexed: 12/22/2022] Open
Abstract
Background The role of various gynaecological imaging modalities is vital in aiding clinicians to diagnose acute gynaecological disease, and can help to direct medical and surgical treatment where appropriate. It is important to interpret the imaging findings in the context of the clinical signs and patient's pregnancy status. Methods Ultrasound and Doppler are readily available in the emergency department, and demonstrate features of haemorrhagic follicular cysts, ovarian cyst rupture, endometriotic cysts and pyosalpinx. Adnexal torsion may also be identified using ultrasound and Doppler, although the diagnosis cannot be safely excluded based on imaging alone. Computed tomography (CT) is not routinely employed in diagnosing acute gynaecological complications. However due to similar symptoms and signs with gastrointestinal and urinary tract pathologies, it is frequently used as the initial imaging modality and recognition of features of gynaecological complications on CT is important. Results Although MRI is not frequently used in the emergency setting, it is an important modality in characterising features that are unclear on ultrasound and CT. Conclusion MRI is particularly helpful in identifying the site of origin of large pelvic masses, such as haemorrhagic uterine fibroid degeneration and fibroid prolapse or torsion. In this article, we review the imaging appearances of gynaecological emergencies in non-pregnant patients. Teaching points • Ultrasonography is easily accessible and can identify life-threatening gynaecological complications. • Tomography scanners and computed radiography are not routinely used but are important to recognise key features. • MRI is used for the characterisation of acute gynaecological complications. • Recognition of the overlap in symptoms between gastrointestinal and gynaecological conditions is essential.
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Affiliation(s)
- Oran Roche
- St Barts & The London NHS trust, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK,
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18
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Abstract
Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. Ovarian torsion and degenerating fibroids occur less frequently. Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.
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Singhal M, Tiwari OM. Sonographic Appearance of Bilateral Hemorrhagic Cysts of the Ovaries With Rupture on Transvaginal Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2010. [DOI: 10.1177/8756479309347780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hemorrhagic ovarian cysts often present with acute abdomen, requiring laparotomy if features are suggestive of rupture. In an appropriate clinical setting, diagnosis may be possible on transvaginal sonography in most cases, but at times it may be difficult to recognize and can be confused with other ominous conditions. The authors describe the sonographic appearance of bilateral hemorrhagic ovarian cysts with rupture.
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Affiliation(s)
- Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - OM Tiwari
- Department of Radiodiagnosis and Imaging, M G M Medical College and M Y Hospital, Indore, India
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20
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Mettler L, Sodhi B, Schollmeyer T, Mangeshikar P. Ectopic pregnancy treatment by laparoscopy, a short glimpse. MINIM INVASIV THER 2009; 15:305-10. [PMID: 17062405 DOI: 10.1080/13645700600771942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ectopic pregnancy is a life-threatening emergency, the incidence of which is increasing globally. There are a number of factors predisposing to this condition; today, the most common of these is salpingitis. Due to advancements in diagnostic technology it is possible to diagnose this condition early and thus try to achieve a favourable outcome for the patient. Treatment options in the form of medical and surgical modalities are widely available. As minimally invasive therapy techniques are rapidly advancing, laparoscopic treatment has become the most popular and preferred method for treating ectopic pregnancy. Both salpingotomy as well as salpingectomy can be performed through the laparoscope. This paper gives a short glimpse at the predisposing factors and the diagnostic investigations available for ectopic pregnancy and an insight into its laparoscopic treatment. It also reviews the pregnancy outcome and laparoscopic treatment of cases at the Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein.
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Affiliation(s)
- L Mettler
- Department of Obstetrics and Gynaecology, Campus Kiel, University Hospitals Schleswig-Holstein, Kiel, Germany.
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Chandrasekhar C. Ectopic pregnancy: a pictorial review. Clin Imaging 2009; 32:468-73. [PMID: 19006776 DOI: 10.1016/j.clinimag.2008.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2007] [Accepted: 02/04/2008] [Indexed: 10/21/2022]
Abstract
Ultrasound has remained the primary modality for investigating the pelvis of women in the reproductive age group, especially in an emergency setting. Recognition of different sonographic presentations, including typical and atypical findings of ectopic pregnancy, is important to determine surgical or nonsurgical management. This pictorial review article will exemplify different sonographic presentations of ectopic pregnancy.
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Affiliation(s)
- Chitra Chandrasekhar
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, LBJ Hospital, Houston, TX 77026-1967, USA.
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Tandulwadkar S, Shah A, Agarwal B. Detorsion and conservative therapy for twisted adnexa: our experience. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2009; 1:21-6. [PMID: 22442506 PMCID: PMC3304263 DOI: 10.4103/0974-1216.51905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: 1) To determine if detorsion of the twisted adnexa is better than traditional adnexectomy to conserve the adnexa and preserve its function. 2) To determine the feasibility of detorsion in conservation of adnexa. Design: Prospective Study from September 2004 to September 2008. Setting: Private IVF and Endoscopy Centre. Patients: 22 patients with twisted adnexa (15 non-pregnant and 7 pregnant). Intervention: Surgical intervention and either detorsion of adnexa or adnexectomy. Main Outcome Measures: Ovarian preservation and conservation of ovarian function in 77.2% cases determined by: a) Follicular development on sonography (performed for one year after adnexectomy). b) Subsequent surgery for unrelated cause showing healthy ovaries. c) controlled ovarian hyperstimulation and successful oocyte retrieval subsequently. Results: We could conserve the adenexa in 77.2% cases. Laparoscopic detorsion was performed in 11/15(73.33 %) of non-pregnant women and adnexectomy done in four women 26.66%. Among the seven pregnant women, adnexa could be preserved in 6/7(85.7%) and only one woman required adnexectomy. Laparotomy was required in 2/22(9%) women both of which were in late second trimester of pregnancy. In one case (4.54%) we had recurrence of torsion. 88.23% of the women with conserved adnexa showed preservation of ovarian function. Conclusion: Our study showed that timely diagnosis and intervention could make the difference between ovarian loss and salvage- an outcome of great importance in population of reproductive age females. Laparoscopy with its many benefits proves to be superior to laparotomy.
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Saul T. Ectopic pregnancy and tubo-ovarian abscess. J Emerg Med 2008; 39:499-500. [PMID: 18842382 DOI: 10.1016/j.jemermed.2008.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 03/20/2008] [Accepted: 04/04/2008] [Indexed: 11/15/2022]
Affiliation(s)
- Turandot Saul
- Department of Emergency Medicine, Emergency Ultrasound Division, St. Luke's/Roosevelt Hospital Center, New York, NY 10019, USA
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Adhikari S, Blaivas M, Lyon M. Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. J Emerg Med 2008; 34:429-33. [PMID: 18242924 DOI: 10.1016/j.jemermed.2007.05.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 03/29/2007] [Accepted: 05/24/2007] [Indexed: 11/24/2022]
Abstract
Tubo-ovarian Abscess (TOA) is a complication of pelvic inflammatory disease (PID) requiring admission, i.v. antibiotics and, possibly, aspiration or surgery. The purpose of this study was to describe the role of emergency department (ED) bedside transvaginal ultrasonography (US) in the diagnosis of TOA. This was a retrospective review of non-pregnant ED patients presenting with pelvic pain who were diagnosed with TOA using bedside transvaginal US. ED US examinations were performed by emergency medicine residents and ultrasound-credentialed attending physicians within 1 h after clinical assessment. ED US logs were reviewed for the diagnosis of TOA. Medical records were reviewed for risk factors, medical and sexual history, physical examination findings, laboratory results, additional diagnostic testing, hospital course, and a discharge diagnosis of TOA by the admitting gynecology service. A total of 20 patients with TOA were identified over a 3-year period. Ages ranged from 14 to 45 years (mean 27 years). Seven (35%) patients reported a prior history of PID or sexually transmitted disease, and 1 (5%) was febrile. All had lower abdominal tenderness and 9 (45%) had cervical motion or adnexal tenderness. The sonographic abnormalities included 14 (70%) with a complex adnexal mass, 5 (25%) with echogenic fluid in the cul-de-sac, and 3 (15%) patients with pyosalpinx. The discharge diagnosis was TOA by the admitting gynecology service for all patients. Our study illustrates the limitations of clinical criteria in diagnosing TOA and supports the use of bedside US when evaluating patients with pelvic pain and symptoms that do not meet classic Centers for Disease Control and Prevention criteria for PID.
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Affiliation(s)
- Srikar Adhikari
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Abstract
Ectopic pregnancy is a high-risk condition that occurs in 1.9% of reported pregnancies. Although the clinical triad of pain, bleeding, and amenorrhea is considered very specific for an ectopic pregnancy, ultrasound plays important role in detecting the exact location of the ectopic pregnancy and also in providing guidance for minimally invasive treatment. This article discusses the main sonographic features of ectopic pregnancy at various common and unusual locations. In addition, it provides insight into the role of hormonal markers in the diagnosis and management of ectopic pregnancy.
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Affiliation(s)
- Shweta Bhatt
- Department of Imaging Sciences, University of Rochester Medical Center, University of Rochester School of Medicine, 601 Elmwood Ave., Box 648, Rochester, NY 14642, USA
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Jindal G, Ramchandani P. Acute Flank Pain Secondary to Urolithiasis: Radiologic Evaluation and Alternate Diagnoses. Radiol Clin North Am 2007; 45:395-410, vii. [PMID: 17601499 DOI: 10.1016/j.rcl.2007.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article discusses the radiologic management of the patient who has acute flank pain. It describes the evolution of radiologic imaging in patients who present with acute symptoms caused by suspected urolithiasis, the advantages of unenhanced helical CT and the limitations of abdominal radiography, intravenous urography, and ultrasonography in this setting, and the alternative diagnoses encountered within the urinary tract, abdomen, and pelvis.
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Affiliation(s)
- Gaurav Jindal
- Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Abstract
Endometriosis is the presence of functional endometrial tissue outside the uterine cavity and the myometrium. It is an important cause of infertility and pelvic pain in women older than 25 years. Endometriomas are relatively common and can mimic other adnexal masses, and ultrasonography is often the first choice of imaging. This pictorial essay presents the sonographic appearance of endometriomas and similar-appearing adnexal masses and their characteristics, which may aid in their differentiation on routine ultrasonographic examination.
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Affiliation(s)
- Shweta Bhatt
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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Blaivas M, Lyon M. Reliability of adnexal mass mobility in distinguishing possible ectopic pregnancy from corpus luteum cysts. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:599-605. [PMID: 15840790 DOI: 10.7863/jum.2005.24.5.599] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the utility of paraovarian pelvic mass mobility as an indicator of mass identity, corpus luteum versus other, in ruling out ectopic pregnancy. METHODS This was a retrospective study of all pelvic sonographic examinations on patients with first-trimester complications seen over an 18-month period at a large urban emergency department. All pregnant patients with signs or symptoms of concern for ectopic pregnancy were scanned to evaluate for intrauterine pregnancy. Masses suggestive of either a corpus luteum or an ectopic pregnancy were separated from the ovary with abdominal palpation and endovaginal transducer movement. The ultrasound director and assistant director reviewed videos of all scans. Results of mass separation and outcome were recorded. Independent movement of a mass and ovary was defined as movement of the mass away from the ovary, sliding past the ovary or rotation past the ovary. Statistical analysis included descriptive statistics, inter-rater reliability, the Fisher exact test, and sensitivity, specificity, and negative and positive predictive values. RESULTS A total of 78 patient scans fit the criteria, and in 27 of them, the mass separated from the ovary. Twenty-three patients had ectopic pregnancy as the final diagnosis, and in 2 of these, no independent mass movement occurred. Lack of independent movement of the mass and ovary was significantly more common in patients without a final diagnosis of ectopic pregnancy (P < .0001). The negative predictive value was 96.1%. CONCLUSIONS Lack of independent movement of an adjacent mass and ovary was strongly associated with absence of ectopic pregnancy.
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Affiliation(s)
- Michael Blaivas
- Department of Emergency Ultrasound, Medical College of Georgia, 1120 15th St, AF-2056, Augusta, GA 30912-4007, USA.
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