Systemic inflammation and the risk of depression in people with type 2 diabetes

Background

Depression is a common co-morbidity in diabetes. The mechanisms underlying the association between depression and diabetes are poorly understood. Although risk factors, such as poor lifestyle behaviours, obesity, and stress have been identified, emerging evidence suggests that systemic inflammation may play an important role in the pathogenesis and recurrence of depression in people with diabetes. The aim of the present study was to evaluate if the inflammatory marker C-reactive protein (CRP) is associated with an increased risk of major depression episodes in people with type 2 diabetes.

Methods

A prospective, community-based study was conducted in Quebec, Canada. Individuals were recruited from the CARTaGENE (CaG) cohort, a population-based survey of Quebec residents aged 40 to 69 years. Our sample included 719 individuals with type 2 diabetes and 1423 individuals without diabetes. Individuals were assessed at baseline and 5 years after baseline. Major depression disorders were assessed using a clinical interview (CIDI). Inflammatory markers were assessed from blood samples. Elevated CRP levels were defined as ≥ 3 mg/L.

Results

Participants with both diabetes and elevated CRP levels had the highest risk of major depressive episodes (adjusted OR = 1.90, 95% CI 1.45, 2.50), compared to those without diabetes and without elevated CRP levels. The risk of major depressive episodes in individuals with diabetes without elevated CRP episodes was lower (adjusted OR = 1.21, 95% CI 0.85, 1.73) and similar to the risk of those without diabetes and elevated CRP levels (adjusted OR = 1.15, 95% CI 0.94, 1.39).

Discussion

The study highlights the interaction between diabetes, inflammatory makers, and depression in a community sample. Early identification, monitoring, and management of elevated inflammation levels might be an important depression prevention strategy in people with type 2 diabetes.

Theory and explanation in demography: The case of low fertility in Europe

In the 50th anniversary edition of Population Studies, John Hobcraft commented that demographers spend too little time trying to explain the phenomena they measure and describe. A quarter of a century on, this paper looks at the state of theory and explanation in contemporary demography. I ask how demographers have approached the task of explanation since Hobcraft's comment, grounding the discussion in the mainstream literature on low fertility in Europe. Using selected examples, I critically review macro- and micro-level approaches to explanation, highlighting some of the philosophical problems that each encounters. I argue that different conceptions of what demography is, and the explanatory language fertility researchers use, lead to differences in explanatory strategies that are rarely explicitly recognized. I also consider how critical theories challenge demographers to think in new ways. Despite the increasing attention paid to theory and explanation, I conclude that more engagement with the philosophy of social sciences is needed before fertility researchers can legitimately claim their studies do as much to explain and understand as to quantify and describe.

VIII. On the movements of the flame in the explosion of gases

(1.) On the Rate of Movement of the Flam, and the produced in theExplosion of Gases. Humphry Davy was the first to observe the rate at which an explosion of gases was propagated in a tube, and he also made the first rough experiment on the tem­perature reached in an explosion. When gas from the distillation of coal (which he found more inflammable than fire-damp) was mixed with eight times its volume ofair, and was fired in a glass tube 1 foot long and 1/4 inch in diameter, the flame took more than a second to traverse the tube. When cyanogen mixed with twice its volume of oxygen was fired in a bent tube over water, the quantity of water displaced showed that the gases had expanded fifteen times their original bulk. Bunsen, in 1867, made the first careful measurement of the rate at which an explosion is propagated in gases, and he also made the first systematic researches on the pressure and temperature produced by the explosion of gases in closed vessels. His results led him to the remarkable conclusion that there was a discontinuous combustion in explosions. When electrolytic gas, or when carbonic oxide with haltits volume of oxygen, is fired, only one-third of the mixture is burnt, according to Bunsen, raising the temperature of the whole to about 3000° C. No further chemical action then occurs until the gaseous mixture falls, by cooling, below 2500° C. Then a further combustion begins, and so on<italic>per Saltum</italic>. These deductions were criticised by Berthelot, who pointed out that they assumed the constancy of the specific heats of steam and of carbonic acid at high temperatures.

The feasibility of using the EQ-5D-3L with adults with mild to moderate learning disabilities within a randomized control trial: a qualitative evaluation

Background

In trials incorporating a health economic evaluation component, reliable validated measures for health-related quality of life (HRQOL) are essential. The EQ-5D is the preferred measure for cost-effectiveness analysis in UK trials. This paper presents a qualitative evaluation of the use of the EQ-5D-3L in a feasibility randomised control trial with participants who had a mild- to  moderate learning disability and type 2 diabetes.

Methods

Researchers administered the EQ-5D-3L to 82 participants at baseline and 77 at follow-up. After each interview, researchers rated the ease of administering the EQ-5D-3L and made free-text entries on the administration experience. For a subset of 16 interviews, researchers audio-recorded more detailed journal entries. Ease of administration data were analysed using descriptive statistics. Free-text responses were subject to a basic content analysis. The EQ-5D-3L-related journal entries were transcribed, coded and analysed thematically.

Results

Over half of participants were perceived to experience difficulty answering some or all of the items in the EQ-5D-3L (60% at baseline; 54% at follow-up). Analysis of the free-text entries and audio journals identified four themes that question the use of the EQ-5D-3L in this population. The first theme is related to observations of participant intellectual ability and difficulties, for example, in understanding the wording of the measure. Theme 2 is related to the normalisation of adjustments for impairments, which rendered the measure less sensitive in this population. Theme 3 is related to researcher adaptation and non-standard administration. An overarching fourth theme was identified in that people with learning disabilities were viewed as ‘unreliable witnesses’ by both researchers and supporters.

Conclusions

It is recommended that the EQ-5D-3L should not be used in isolation to assess health-related quality of life outcomes in trials research in adults with a learning disability. Further research is required to develop and evaluate a version of the EQ-5D appropriate for this population in trials research. It is unrealistic to expect that adjustments to the wording alone will deliver an appropriate measure: supporter or researcher involvement will almost always be required. This requirement needs to be factored into the development and administration guidelines of any new version of the EQ-5D for adults with a learning disability.

Trial registration

Current Controlled Trials ISRCTN41897033 [registered 21 January 2013].

Electronic supplementary material

The online version of this article (10.1186/s40814-018-0357-6) contains supplementary material, which is available to authorized users.

Engaged parenting, gender, and children's time use in transnational families: An assessment spanning three global regions

Global circuits of migration regularly separate parents from children. How families navigate this separation has changed markedly. The sharp decline in the cost of international communication makes possible new forms of transnational parenting. In many contexts, migrants are now actively engaged parents, involved in decisions, knowledgeable of children's schooling, employment, and activities, and in some cases, even conversant face-to-face with children via videoconferencing. These practices, however, are not universal. We use data from surveys in three countries to document the frequency and variability of intensive, engaged transnational parenting in the diverse global regions of Asia, Africa, and the Americas. We then ask whether the organisation of children's lives-specifically, time allocated to school homework, leisure, and household chores-varies by the degree to which migrant parents stay connected to sending homes. The gender of the migrant parent, stay-behind caregiver, and the gender of the child emerge as explanatory factors for engaged parenting and children's time use. However, and unexpectedly, in the Philippines, migrant mothers are less likely to practice engaged parenting. In sending households, girls in two of the three countries spend more time doing household chores than boys, but parental migration does not mitigate this difference. Although we find some evidence of more traditional gender practices, we also find exceptions that suggest potentially fruitful avenues for future research.

The projected effect on insects, vertebrates, and plants of limiting global warming to 1.5°C rather than 2°C

In the Paris Agreement on Climate Change, the United Nations is pursuing efforts to limit global warming to 1.5°C, whereas earlier aspirations focused on a 2°C limit. With current pledges, corresponding to ~3.2°C warming, climatically determined geographic range losses of >50% are projected in ~49% of insects, 44% of plants, and 26% of vertebrates. At 2°C, this falls to 18% of insects, 16% of plants, and 8% of vertebrates and at 1.5°C, to 6% of insects, 8% of plants, and 4% of vertebrates. When warming is limited to 1.5°C as compared with 2°C, numbers of species projected to lose >50% of their range are reduced by ~66% in insects and by ~50% in plants and vertebrates.

'Geraniums (red) and Delphiniums (blue)': Trauma, Ethics, and Medical Communications

More official complaints about medical treatment in the UK relate to poor communications than to wrong diagnoses. This article, in considering the importance of communications training for clinicians, is structured into three sections. From use of a story that introduces the idea of miscommunication and trauma in the first section, the article moves, in the second, to a theorisation of trauma as a concept, addressing issues of intersubjectivity, the relationship between embodied and psychological being, and ethics. From this, the third section engages directly with medical communications training, exemplifying a particular literary-studies approach to matters of communication.

Choosing to Remain Childless? A Comparative Study of Fertility Intentions Among Women and Men in Italy and Britain

Pathways to childlessness may differ not only between individuals but also at the population level. This paper investigates differences in childlessness by comparing two countries—Britain and Italy—where levels of childlessness are high in comparison with many other European countries, but which have distinct fertility trajectories and family regimes. Using data from two large, representative national samples of women and men of reproductive age in a co-residential partnership, it presents a rich analysis of the characteristics associated with intended childlessness, net of the aspects associated with being childless at interview. Although childlessness intentions are generally comparable between men and women of the same age, results show a link between socio-economic disadvantage and childlessness for British men as well as the importance of men’s employment for childbearing decisions in Italy. These findings support the view that pathways into childlessness are gendered and highlight the importance of partnership context in the understanding of fertility intentions. Then, the level of childlessness at interview is comparable across the two countries. However, a higher proportion of respondents in Italy is only provisionally childless, whereas a larger proportion of British respondents intends to remain childless. Framing these differences in fertility intentions within the wider context of family and fertility regimes allows insight into the extent to which observed levels of lifetime childlessness at the population level might result from a specific combination of intended childlessness, postponed decisions leading to involuntary childlessness, or constraints affecting abilities to achieve intentions at the individual level.

The Role of Children’s Education for the Mental Health of Aging Migrants in Europe

Abstract. In this study, using SHARE data we examined whether the education of adult children is associated with depressive symptoms (EURO-D caseness) for older immigrants and nonimmigrants in Europe. After controlling for possible confounders, we found that the education of adult children has independent effects on the mental health of their parents, and that having children with upper secondary or tertiary levels of education significantly lessen the odds of immigrants experiencing depressive symptoms. Furthermore, regular contact between parents and their adult children exerts a positive influence as well as amplifying the relationship between children’s education and mental health. Taken together, the results demonstrate that, were it not for family social capital, older immigrants might experience much worse mental health outcomes.

Transnational migration, changing care arrangements and left-behind children's responses in South-east Asia

Recent increases in the volume of labour migration from South-east Asia - and in particular the feminisation of these movements - suggest that millions of children are growing up in transnational families, separated from their migrant parents. Drawing on both quantitative and qualitative data collected in Indonesia, the Philippines, Thailand and Vietnam, the study seeks to elucidate care arrangements for left-behind children and to understand the ways in which children respond to shifts in intimate family relations brought about by (re)configurations of their care. Our findings emphasise that children, through strategies of resistance, resilience and reworking, are conscious social actors and agents of their own development, albeit within constrained situations resulting from their parents' migration.

Parental migration and the mental health of those who stay behind to care for children in South-East Asia

The international migration of parents from the global south raises questions about the health impacts of family separation on those who stay behind. This paper uses data collected in 2008 and 2009 for a project on Child Health and Migrant Parents in South-East Asia (CHAMPSEA) to address a largely neglected research area by investigating the mental health of those who stay behind in Indonesia, Philippines and Vietnam to care for the children of overseas migrants. A mixed-methods research design is employed to answer two questions. First, whether carers in transnational (migrant) households are more likely to suffer mental health problems than those in non-migrant households; and secondly, whether transnational family practices and characteristics of migration are associated with mental health outcomes for stay-behind carers. The Self-Reporting Questionnaire (SRQ-20) was completed by carers in selected communities (N = 3026) and used to identify likely cases of common mental disorders (CMD). Multivariate logistic regression and thematic analysis of qualitative interviews (N = 149) reveal a nuanced picture. All stay-behind carers in the Indonesian sample are more likely than carers in non-migrant households to suffer CMD. Across the three study countries, however, it is stay-behind mothers with husbands working overseas who are most likely to experience poor mental health. Moreover, infrequent contact with the migrant, not receiving remittances and migrant destinations in the Middle East are all positively associated with carer CMD, whereas greater educational attainment and greater wealth are protective factors. These findings add new evidence on the 'costs' of international labour migration and point to the role of gendered expectations and wider geopolitical structures. Governments and international policy makers need to intervene to encourage transnational family practices that are less detrimental to the mental health of those who stay behind to care for the next generation.

Geographical variations in fertility and transition to second and third birth in Britain

Geographical variations in fertility have been observed within several countries in Northern Europe, with higher fertility in rural areas, smaller settlements and city suburbs. However, the processes underlying such fertility variations across residential contexts are not well understood. This paper contributes to the on-going debate by looking at local variations in fertility in Britain. It aims to disentangle the relative contribution of a number of factors, including the socio-economic characteristics of individuals, housing conditions, patterns of residential relocation and lastly, contextual factors stricto sensu. In addition, it seeks to identify those aspects of reproductive behaviour which are more likely to be associated with the observed spatial differences, and to distinguish between those that may be influenced by local context and those that respond to social influences at different scales. The focus is on local fertility contexts which, we argue, have the potential to influence the fertility behaviour of individuals through processes of social learning. Individual level data from the British Household Panel Survey and methods of event history analysis are used to explore women's transitions to second and third order births in Britain in the early 21st century. Our findings indicate that individual reproductive life paths respond to a variety of social processes acting at various scales, and that these influences vary by birth order. Most interestingly, local fertility contexts influence transition to first birth but not transition to higher order births, which are mainly associated with individual characteristics of women and their partners. Dominant spacing effects, however, suggest that local contexts have an indirect impact on second and third births through age at the onset of childbearing. The study demonstrates the importance of considering social interaction theories, and their extension to scale-sensitive spatial contexts in which these interactions take place, when analysing geographical variations in fertility. Future research seeking to explain subnational fertility variations must recognize the importance of developing theoretical understandings to inform empirical work.

Does Having a Migrant Parent Reduce the Risk of Undernutrition for Children Who Stay Behind in South-East Asia?

Many parents from South-East Asia who go overseas to work are motivated by a desire to secure a better future for their children, yet the health consequences for children who stay behind are poorly understood. This study is the first cross-country comparison to explore the relationships between parental migration and the risk of undernutrition (stunting) for primary school-aged children. The analysis uses data from the CHAMPSEA Project for children aged 9 to 11 years in the Philippines (N = 480) and Vietnam (N = 482). A series of logistic regression models compares outcomes for children living in transnational households and children living with both parents in non-migrant households in the same communities. We find no general advantage of having a migrant parent. Rather there is a reduced risk of stunting only for some left-behind children in the Philippines, whereas having a caregiver with low educational attainment is a major risk factor for all children. The findings point to a complex set of relationships between parental migration and child nutrition, possibly reflecting differential opportunities for accumulating household wealth through overseas earnings. Moreover, differences between the two countries caution against generalizing across national or cultural groups. We conclude by considering the implications of the findings for theories of transnationalism and for the UN Millennium Development Goal of reducing childhood undernutrition.

Gastrocnemius flap reconstruction of soft-tissue defects following infected total knee replacement

A soft-tissue defect over an infected total knee replacement (TKR) presents a difficult technical problem that can be treated with a gastrocnemius flap, which is rotated over the defect during the first-stage of a revision procedure. This facilitates wound healing and the safe introduction of a prosthesis at the second stage. We describe the outcome at a mean follow-up of 4.5 years (1 to 10) in 24 patients with an infected TKR who underwent this procedure. A total of 22 (92%) eventually obtained a satisfactory result. The mean Knee Society score improved from 53 pre-operatively to 103 at the latest follow-up (p < 0.001). The mean Western Ontario and McMaster Universities osteoarthritis index and Short-Form 12 score also improved significantly (p < 0.001).

This form of treatment can be used reliably and safely to treat many of these complex cases where control of infection, retention of the components and acceptable functional recovery are the primary goals.

Cite this article: Bone Joint J 2013;95-B:1217–21.

Alcohol Use among Very Early Adolescents in Vietnam: What Difference Does Parental Migration Make?

Little is known about the patterns of alcohol use among adolescents and the transmission of alcohol use behaviors from parents to children, including the passage into responsible and problem drinking, in the developing world. The following paper uses primary data from the Child Health and Migrant Parents in South-East Asia (CHAMPSEA) Project for older children aged 9, 10 and 11 to examine the prevalence (16.2 percent) and correlates of alcohol use initiation including parental migration status, caregiving arrangements and exposure to environmental alcohol use (family and friends) in Vietnam. Contrary to expectations, there is no observed migrant 'deficit.' There is some indication that early adolescents in the care of their grandparents are less likely to have a history of experimentation with alcohol use, although it is fully attenuated after controlling for other factors. Peer use is the most powerful explanatory measure of early adolescent drinking, with early adolescents more than five times as likely to have ever drunk alcohol if their friends drink also, and as expected, there is a strong child gender difference with girls much less likely to have a history of alcohol use. "A man without alcohol is like a flag without wind"- Popular Vietnamese saying.

Resilience and well-being among children of migrant parents in South-East Asia

There has been little systematic empirical research on the well-being of children in transnational households in South-East Asia—a major sending region for contract migrants. This study uses survey data collected in 2008 from children aged 9, 10, and 11 and their caregivers in Indonesia, the Philippines, and Vietnam (N = 1,498). Results indicate that while children of migrant parents, especially migrant mothers, are less likely to be happy compared to children in nonmigrant households, greater resilience in child well-being is associated to longer durations of maternal absence. There is no evidence for a direct parental migration effect on school enjoyment and performance. The analyses highlight the sensitivity of results to the dimension of child well-being measured and who makes the assessment.

Immunity through early development of coral larvae

As a determinant of survival, immunity is likely to be significant in enabling coral larvae to disperse and successfully recruit, however, whether reef-building coral larvae have immune defenses is unknown. We investigated the potential presence and variation in immunity in the lecithotrophic larvae of Acropora tenuis through larval development. Enzymes indicative of tyrosinase and laccase-type melanin-synthesis were quantified, and the concentration of three coral fluorescent proteins was measured over six developmental stages; egg, embryo, motile planula, planula post-exposure to crustose coralline algae (CCA; settlement cue), settled, settled post-exposure to Symbiodinium (endosymbiont). Both types of melanin-synthesis pathways and the three fluorescent proteins were present in A. tenuis throughout development. Laccase-type activity and red fluorescence increased following exposure of planula to CCA, whereas tyrosinase-type activity and cyan fluorescence increased following settlement. No change was detected in the measured parameters following exposure to Symbiodinium. This study is the first to document coral larval immune responses and suggests the melanin-synthesis pathways have disparate roles-the laccase-type potentially non-immunological and the tyrosinase-type in cytotoxic defense. Our results indicate that corals have the potential to resist infection from the earliest life history phase.

Transnational families and the family nexus: perspectives of Indonesian and Filipino children left behind by migrant parent(s)

As a significant supplier of labour migrants, Southeast Asia presents itself as an important site for the study of children in transnational families who are growing up separated from at least one migrant parent and sometimes cared for by 'other mothers'. Through the often-neglected voices of left-behind children, we investigate the impact of parental migration and the resulting reconfiguration of care arrangements on the subjective well-being of migrants' children in two Southeast Asian countries, Indonesia and the Philippines. We theorise the child's position in the transnational family nexus through the framework of the 'care triangle', representing interactions between three subject groups- 'left-behind' children, non-migrant parents/other carers; and migrant parent(s). Using both quantitative (from 1010 households) and qualitative (from 32 children) data from a study of child health and migrant parents in Southeast Asia, we examine relationships within the caring spaces both of home and of transnational spaces. The interrogation of different dimensions of care reveals the importance of contact with parents (both migrant and nonmigrant) to subjective child well-being, and the diversity of experiences and intimacies among children in the two study countries.

Migrant Parents and the Psychological Well-Being of Left-Behind Children in Southeast Asia

Several million children currently live in transnational families, yet little is known about impacts on their health. We investigated the psychological well-being of left-behind children in four Southeast Asian countries. Data were drawn from the CHAMPSEA study. Caregiver reports from the Strengths and Difficulties Questionnaire (SDQ) were used to examine differences among children under age 12 by the migration status of their household (N = 3,876). We found no general pattern across the four study countries: Indonesia, the Philippines, Thailand, and Vietnam. Multivariate models showed that children of migrant fathers in Indonesia and Thailand are more likely to have poor psychological well-being, compared to children in nonmigrant households. This finding was not replicated for the Philippines or Vietnam. The paper concludes by arguing for more contextualized understandings.

On the fringes of conquest: maya-spanish contact in colonial belize

The defeat of the Aztecs of Mexico by Hernán Cortés in 1521 was but the beginning of a long and torturous conquest of Central America that did not always result in the mastery of people and production for which the Spanish had hoped. The Maya of the resource-poor Yucatán peninsula were spared the heavy colonial hand that held fast to central Mexico and its riches. In addition, the dense forests of the peninsula served as a haven for refugees fleeing oppressive conditions in colonial towns. Despite the paucity of documentary information on Maya communities of the frontier, knowledge of Maya-Spanish relations in the 16th and 17th centuries has advanced in recent years through archeological and ethnohistorical research. Work in one region of the Maya lowlands has brought us closer to an understanding of the early interaction of the rulers and the ruled.

A case of aspergillus endophthalmitis in an immuncompetent woman: intra-ocular penetration of oral voriconazole: a case report

Background

There are very few reports of Aspergillus fumigatus causing endogenous endophthalmitis (EAE) in immunocompetent individuals although it is well recognised in the immunocompromised. Treatment can be with intravitreal, intravenous and oral antifungal agents. The benefit of an oral agent is clear however the concentration of voriconazole in the inflamed eye after oral administration has not previously been documented.

Case presentation

We present a case of EAE in an immunocompetent 78-year-old Caucasian female who was subsequently managed with oral voriconazole. Using a bioassay, we show an appropriate voriconazole concentration in serum and vitreous samples.

Conclusion

This case adds to the limited literature on the prevalence of endogenous endophthalmitis in immunocompetent patients and supports the use of voriconazole in such cases.

Development of homogeneous high-affinity agonist binding assays for 5-HT2 receptor subtypes

The serotonin (5-hydroxytryptamine) 5-HT2 receptor subfamily consists of three members, 5-HT2A, 5-HT2B, and 5-HT2C. These receptors share high homology in their amino acid sequence, have similar signaling pathways, and have been indicated to play important roles in feeding, anxiety, aggression, sexual behavior, mood, and pain. Subtype-selective agonists and antagonists have been explored as drugs for hypertension, Parkinson's disease, sleep disorders, anxiety, depression, schizophrenia, and obesity. In this study, we report the development of homogeneous agonist binding assays in a scintillation proximity assay (SPA) format to determine the high-affinity binding state of agonist compounds for the human 5-HT2C, 5-HT2A, and 5-HT2B receptors. The 5-HT2 agonist 1-(4- [125I]iodo-2,5-dimethoxyphenyl)-2-aminopropane ([125I]DOI) was used to label the high-affinity sites for the 5-HT2A and 5-HT2C receptors. The high-affinity sites for the 5-HT2B receptor were labeled with [3H]lysergic acid diethylamide. Total receptor expression was determined with the 5-HT2 antagonist [3H]mesulergine for the 5-HT2B and 5-HT2C receptors, and [3H]ketanserin for the 5-HT2A receptor. The agonist high-affinity binding sites accounted for 2.3% (5-HT(2C) receptor), 4.0% (5-HT2A receptor), and 22% (5-HT2B receptor) of the total receptor population. Competition binding studies using known agonists indicated high Z' values of the agonist binding assays in SPA format (Z' > 0.70). The Ki values of 5-HT, (R)(-)DOI, and VER-3323 for the 5-HT2A, 5-HT2B, and 5-HT2C receptors by SPA format were equivalent to published data determined by filtration binding assays. These results indicate that agonist binding assays in SPA format can be easily adapted to a high throughput assay to screen for selective 5-HT2C receptor agonists, as well as for selectivity profiling of the compounds.

Dopaminergic dysfunction in unrelated, asymptomatic carriers of a single parkin mutation

Parkin disease is usually autosomal recessive; however, two studies have shown that asymptomatic heterozygotes have nigrostriatal dysfunction and even manifest subtle extrapyramidal signs. The authors used 18F-dopa PET to study 13 asymptomatic parkin heterozygotes and found a significant reduction of (18)F-dopa uptake in caudate, putamen, ventral, and dorsal midbrain compared with control subjects. Four had subtle extrapyramidal signs. Parkin heterozygosity is a risk factor for nigrostriatal dysfunction and in some may contribute to late-onset Parkinson disease.

Acoustic streaming: a new technique for assessing adnexal cysts

OBJECTIVES

To determine whether acoustic streaming has clinical value in the differentiation between various ovarian and adnexal cysts.

METHODS

We assessed 29 adnexal cysts, for which pathological diagnosis was available, for the presence of acoustic streaming during B-mode and color sonographic evaluation.

RESULTS

Acoustic streaming was detected in 15 (52%) of the cysts. The most common cyst, endometrioma (n = 7), did not exhibit acoustic streaming in any case, while of the remaining 22 cysts, 15 exhibited acoustic streaming (P = 0.0017). Dermoid cysts exhibited acoustic streaming in two of six (33%) cases. In addition acoustic streaming was noted in two of two (100%) hemorrhagic cysts, eight of ten (80%) cystadenomas, two of three (67%) malignant cysts and in the one abscess.

CONCLUSIONS

Acoustic streaming is the first sonographic feature that may be able to completely exclude endometrioma as a possible diagnosis for an adnexal cyst.