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Park JH, Song JY, Chung YJ, Kim MR. A Rare Image of Fallopian Tube Anomaly: Ampullary Accessory Fallopian Tube Ostia. J Minim Invasive Gynecol 2024; 31:355-356. [PMID: 38417675 DOI: 10.1016/j.jmig.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Jung Hyun Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Yen Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn-Jee Chung
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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Bursać D, Zadro M, Haramina S, Bošnjak DC, Tučkar N, Kuna K. Unusual presentation of late-stage ectopic tubal pregnancy (19 weeks' gestation): Case report and literature review. Eur J Obstet Gynecol Reprod Biol 2024; 295:150-152. [PMID: 38359636 DOI: 10.1016/j.ejogrb.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
Ectopic pregnancy is a medical condition in which a fertilized egg takes an unexpected detour away from the uterine cavity and the fallopian tube becomes a popular host, with the ampulla being the prime location. However, it can occur in other areas such as cervix, ovaries, or abdomen. The most common risk factors are pelvic inflammatory disease, previous pelvic or abdominal surgery, abnormal anatomy of genital organs, endometriosis, previous ectopic pregnancies, assisted reproductive technologies, endocrine disorders, and even the subtle influence of low-dose progestins from contraceptives. We will present a rare case of unrecognized late-stage tubal ectopic pregnancy. The following case report is of a 25-year-old Caucasian female patient (G2, P0) who presented to the emergency department with a 24-hour abdominal pain syndrome. The patient did not have a gynecological examination for this reason. During the examination, taking into account the clinical and ultrasound findings, a suspicion of pregnancy in a bicornuate uterus was raised, and an MRI of the pelvis was performed. MRI showed ectopic pregnancy in the left fallopian tube with a properly developed fetus that corresponded to a gestation of 19 weeks. An emergency laparotomy was performed and the left fallopian tube with the fetus was removed. The early and late course of recovery went smoothly. The patient was discharged after adequate clinical development.
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Affiliation(s)
- Danijel Bursać
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia; University of North, University Center Varaždin, Croatia
| | - Matilda Zadro
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
| | - Suzana Haramina
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
| | - Diana Culej Bošnjak
- Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
| | - Neven Tučkar
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia; Faculty of Kinesiology, University of Zagreb, Croatia
| | - Krunoslav Kuna
- Department of Obstetrics and Gynecology, University Hospital Sisters of Charity, Zagreb, Croatia
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3
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Yang P, Zhong Y, Zhang C, Zhang Y, Fan X, Shi H. Contrast Agent Reflux in Transvaginal 4-D Hysterosalpingo-Contrast Sonography: Influencing Factors and Coping Strategies. Ultrasound Q 2024; 40:61-65. [PMID: 37771069 DOI: 10.1097/ruq.0000000000000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
ABSTRACT Transvaginal 4-D hysterosalpingo-contrast sonography (TV 4-D HyCoSy) plays an important role in the detection and diagnosis of clinical female infertility. The purposes of this study were to analyze the influencing factors of TV 4murD HyCoSy complicated with contrast agent reflux and to provide evidence for clinical diagnosis and treatment. Female patients diagnosed as infertility by transvaginal hysterosalpingography from January 2021 to December 2022 were included. The characteristics of patients with and without contrast agent reflux were evaluated. Pearson correlation and logistic regression were conducted to analyze the related factors affecting the occurrence of contrast reflux. A total of 416 patients undergoing TV 4-D HyCoSy were included, and the incidence of contrast agent reflux in patients undergoing TV 4-D HyCoSy was 38.94%. Pearson correlation analysis results indicated that history of uterine cavity operation ( r = 0.556), adenomyosis of uterus ( r = 0.584), examination on less than 5 days after menstruation ( r = 0.602), endometrial thickness ( r = 0.566), and endometrial polyps ( r = 0.575) are all correlated with contrast agent reflux in patients undergoing 4-D HyCoSy (all P < 0.05). Logistic regression analysis showed that history of uterine cavity operation (odds ratio [OR], 1.109; 95% confidence interval [CI], 1.012-1.872), adenomyosis of uterus (OR, 2.026; 95% CI, 1.864-2.425), examination on less than 5 days after menstruation (OR, 2.465; 95% CI, 2.118-2.851), endometrial thickness less than 6 mm (OR, 2.866; 95% CI, 2.095-2.957), and endometrial polyps (OR, 1.587; 95% CI, 1.137-1.744) were the influencing factors of contrast agent reflux in patients undergoing (all P < 0.05). The incidence of contrast agent reflux in TV 4-D HyCoSy is high, and there are many influencing factors. Clinical medical workers should take early measures based on these influencing factors to reduce the contrast agent reflux.
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Affiliation(s)
- Ping Yang
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Yue Zhong
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Chao Zhang
- Department of Cardiovascular Medicine, The First People's Hospital of Neijiang, Neijiang, China
| | - Yaping Zhang
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Xu Fan
- Department of Ultrasound, The First People's Hospital of Neijiang
| | - Hong Shi
- Department of Ultrasound, The First People's Hospital of Neijiang
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4
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Chahine R, Zadeh C, Zeid FA, Al-Kutoubi A. Hysterosalpingography: a step up for dose reduction. Clin Radiol 2024; 79:e89-e93. [PMID: 37923624 DOI: 10.1016/j.crad.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/28/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
AIM To evaluate the efficiency of last image capture in interpreting a hysterosalpingogram (HSG) when compared to conventional spot views; to confirm its validity in showing pathology; to establish its use as the preferred method; and to decrease the radiation dose to the patient. MATERIALS AND METHODS The study population consisted of women aged ≥18 years. A standard technique was performed including additional five last image capture after each spot view. Every patient had two stacks of images, one with the exposure film and one with the last image capture. The images were interpreted separately (high-dose versus low-dose) and blindly by two radiologists with different levels of training assessing for uterine abnormalities, fallopian tube abnormalities, peritoneal spillage, and incidental findings. Inter-reading variability was calculated using Kohen's kappa. RESULTS Discrepancies between exposure film and last image capture were detected in only a minority of cases for all variables. Except for the presence of strictures, there was at least substantial agreement between the readers and almost perfect agreement regarding peritoneal spillage and fallopian tube patency, both on exposure film and last image capture. CONCLUSION Reduction in radiation dose without compromising the diagnostic efficacy of HSG is mandatory. If the study is of sufficient quality and deemed negative on last image capture, conventional spot view can be avoided. If further detail is required, standard spot views can still be obtained. Using last image capture instead of spot films has the potential to reduce the overall radiation dose by up to 78%.
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Affiliation(s)
- R Chahine
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - C Zadeh
- Department of Diagnostic Radiology, University of Iowa Healthcare, Iowa City, Iowa, USA
| | - F Abou Zeid
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Al-Kutoubi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
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5
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Traisrisilp K, Sethasathien S. Large unruptured tubal pregnancy mimicking abdominal pregnancy. BMJ Case Rep 2023; 16:e256090. [PMID: 37816580 PMCID: PMC10565280 DOI: 10.1136/bcr-2023-256090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Ectopic pregnancy accounts for 1-2% of all pregnancies. Ultrasound is the primary diagnostic tool to locate pregnancy outside the uterus and identify complications such as haemoperitoneum. In inconclusive cases, MRI is an adjunctive imaging modality offering more precise tissue differentiation and helpful to location identification. Presented is an unusual case of tubal pregnancy. The patient in her 30s, who was 14 weeks into her first pregnancy, had a suspected abdominal pregnancy. Both transabdominal ultrasound and an MRI indicated an ectopic pregnancy, likely originating from the right fallopian tube. A successful laparotomy and right salpingectomy were performed without complications. Rarely, as in this case, large unruptured and advanced tubal pregnancies can mimic an abdominal pregnancy, underscoring the importance of disease recognition and familiarity with uncommon image findings. An accurate diagnosis of pregnancy location is crucial for effective case management.
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Affiliation(s)
- Kuntharee Traisrisilp
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
| | - Sethawat Sethasathien
- Obstetric and Gynecology, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
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Crosier CJ, Ricca RL. Isolated Fallopian Torsion: A Pediatric Case Series. Am Surg 2023; 89:3917-3919. [PMID: 37204787 DOI: 10.1177/00031348231175118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Isolated fallopian tube torsion is a rare cause of acute abdominal pain in adolescent females. It is known to be a surgical emergency as it may lead to ischemia of the fallopian tube which can result in necrosis, infertility or infection. Presenting symptoms and radiographic findings are vague making diagnosis difficult, often requiring direct visualization in the operating room to make the definitive diagnosis. There has been an increase in this diagnosis at our institution in the previous year prompting compilation of cases and a literature review.
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Affiliation(s)
| | - Robert L Ricca
- Department of Pediatric Surgery, Prisma Health Upstate, Greenville, SC, USA
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7
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Zhao M, Nie H, Wang H, Fang J, Wang F, Wang H, Yu H, Bai X, Zhang Y, Xiong Q, Cai H, Zhao Q. Novel oviduct endoscope combining optical coherence tomography with intratubal ultrasonography for fallopian tube exploration: An in vivo rabbit pilot study. Photodiagnosis Photodyn Ther 2023; 43:103650. [PMID: 37302641 DOI: 10.1016/j.pdpdt.2023.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND STUDY AIM Currently, several limitations exist in the examination of the oviduct. In this study, the usefulness and feasibility of a novel ultrafine dual-modality oviduct endoscopy device for in vivo assessment of the oviduct were evaluated. METHODS Five Japanese white rabbits were selected to undergo oviduct probing using a combination of optical coherence tomography (OCT) and intratubal ultrasonography. The feasibility of the procedure was evaluated through 152 pairs of clear, clinically interpretable images obtained using spiral scanning via the pull-back method. OCT images were compared with the oviduct histopathology sections. RESULTS Visualization of the oviduct using both OCT and ultrasound revealed a differentiated three-layer tissue; however, ultrasound showed a poorer clarity than OCT. By comparing OCT images with the histological morphology of the oviduct, the inner low-reflective layer of the oviduct corresponds to the mucosal layer, the middle high-reflective layer corresponds to the fibrous muscle layer, and the outer low-reflective layer corresponds to the connective tissue layer. Postoperatively, the general condition of the animals was good. CONCLUSION This study demonstrated the feasibility and potential clinical value of the novel ultrafine dual-modality oviduct endoscope. Dual-modality imaging of OCT and intratubal ultrasonography can provide clearer microstructure of the oviduct wall.
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Affiliation(s)
- Mengya Zhao
- Department of Gynecologic Oncology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Haihang Nie
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hongling Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Fan Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Haizhou Wang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | - Hualiang Yu
- InnerMedical Co. Ltd, Shenzhen 518000, China
| | | | - Yafei Zhang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
| | | | - Hongbing Cai
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Qiu Zhao
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China; Clinical Center and Key Lab of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China.
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8
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Ford J, Hince D, Lee E, Lo G. Intravasation complicating hysterosalpingo-foam sonography (HyFoSy) using ExEm® Foam. Aust N Z J Obstet Gynaecol 2023; 63:577-582. [PMID: 37185818 DOI: 10.1111/ajo.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Transvaginal hysterosalpingo-foam sonography (HyFoSy) assesses tubal patency in an outpatient setting and without ionising radiation, unlike traditional hysterosalpingography (HSG) under fluoroscopy. Like HSG, HyFoSy may be complicated by uterine intramural contrast leak, leading to venous intravasation. Intravasation of particulate contrast agents risks pulmonary or cerebral emboli. AIMS We aimed to assess the intravasation rate of HyFoSy using ExEm® Foam and association with endometrial thickness, ExEm® Foam volume, uterine length, adenomyosis severity, uterine morphology or pain score. METHODS An ethics-approved retrospective study on all HyFoSy examinations between 23 January 2018 and 27 October 2021 on sub-fertile patients, trying to conceive. Initial transvaginal sonography confirmed anatomy, uterine morphology, adenomyosis severity and endometrial thickness. Subspecialist radiologists performed HyFoSy with sonographer assistance. Intravasation was identified in real time but also checked for afterwards. Patients were asked to rate instillation pain/discomfort from one to ten immediately afterward. RESULTS Four hundred and thirty-six (n = 436) patients met inclusion criteria. Thirty (6.9%) experienced intravasation. Endometrial thickness and pain score were associated with intravasation. For every millimetre increase in endometrial thickness, the odds of intravasation decreased by 26% (P = 0.010). For every point increase on the pain scale, the odds of intravasation increased by 22% (P = 0.032). There was no evidence of an association between instilled ExEm® Foam volume or the other previously published parameters with intravasation. CONCLUSION A 6.9% rate of intravasation was observed. Both endometrial thickness and pain score were significantly associated with intravasation. There was no evidence of an association between ExEm® Foam volume and intravasation.
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Affiliation(s)
- Jemma Ford
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
| | - Dana Hince
- Institute for Health Research, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Emmeline Lee
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
| | - Glen Lo
- Western Ultrasound For Women, Perth, Western Australia, Australia
- Sir Charles Gairdner Osborne Park Hospital Care Group, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
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9
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Li S, Luo H, Kou S, Hagemann IS, Zhu Q. Depth-resolved attenuation mapping of the human ovary and fallopian tube using optical coherence tomography. J Biophotonics 2023; 16:e202300002. [PMID: 36916760 PMCID: PMC10656701 DOI: 10.1002/jbio.202300002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 06/07/2023]
Abstract
Due to the lack of reliable early-diagnostic tools, most ovarian cancers are diagnosed at late stages. Although optical coherence tomography (OCT) has shown promise for identifying diseased ovaries and fallopian tubes at an earlier stage, previous studies either did not provide quantitative scattering mapping or simply used Beer's law to fit the scattering coefficients of each A-line. In this paper, we calculated the pixel-wise attenuation coefficients of ovaries and fallopian tubes in OCT images. Data from 73 freshly excised human ovaries and fallopian tubes from 36 patients have shown that statistical features are statistically different between cancerous ovaries, infundibula, and fimbriae and normal ones.
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Affiliation(s)
- Shuying Li
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
| | - Hongbo Luo
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
| | - Sitai Kou
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
| | - Ian S. Hagemann
- Department of Pathology & Immunology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
- Department of Obstetrics & Gynecology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
| | - Quing Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, 63130 St. Louis, Missouri, USA
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, 63130, USA
- Department of Radiology, Washington University School of Medicine, 63110 St. Louis, Missouri, USA
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10
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Kamphuis D, Rosielle K, van Welie N, Roest I, van Dongen AJCM, Brinkhuis EA, Bourdrez P, Mozes A, Verhoeve HR, van der Ham DP, Vrouenraets FPJM, Risseeuw JJ, van de Laar T, Janse F, den Hartog JE, de Hundt M, Hooker AB, Huppelschoten AG, Pieterse QD, Bongers MY, Stoker J, Koks CAM, Lambalk CB, Hemingway A, Li W, Mol BWJ, Dreyer K, Mijatovic V. The effectiveness of immediate versus delayed tubal flushing with oil-based contrast in women with unexplained infertility (H2Oil-timing study): study protocol of a randomized controlled trial. BMC Womens Health 2023; 23:233. [PMID: 37149639 PMCID: PMC10164300 DOI: 10.1186/s12905-023-02385-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND In women with unexplained infertility, tubal flushing with oil-based contrast during hysterosalpingography leads to significantly more live births as compared to tubal flushing with water-based contrast during hysterosalpingography. However, it is unknown whether incorporating tubal flushing with oil-based contrast in the initial fertility work-up results to a reduced time to conception leading to live birth when compared to delayed tubal flushing that is performed six months after the initial fertility work-up. We also aim to evaluate the effectiveness of tubal flushing with oil-based contrast during hysterosalpingography versus no tubal flushing in the first six months of the study. METHODS This study will be an investigator-initiated, open-label, international, multicenter, randomized controlled trial with a planned economic analysis alongside the study. Infertile women between 18 and 39 years of age, who have an ovulatory cycle, who are at low risk for tubal pathology and have been advised expectant management for at least six months (based on the Hunault prediction score) will be included in this study. Eligible women will be randomly allocated (1:1) to immediate tubal flushing (intervention) versus delayed tubal flushing (control group) by using web-based block randomization stratified per study center. The primary outcome is time to conception leading to live birth with conception within twelve months after randomization. We assess the cumulative conception rate at six and twelve months as two co-primary outcomes. Secondary outcomes include ongoing pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, number of complications, procedural pain score and cost-effectiveness. To demonstrate or refute a shorter time to pregnancy of three months with a power of 90%, a sample size of 554 women is calculated. DISCUSSION The H2Oil-timing study will provide insight into whether tubal flushing with oil-based contrast during hysterosalpingography should be incorporated in the initial fertility work-up in women with unexplained infertility as a therapeutic procedure. If this multicenter RCT shows that tubal flushing with oil-based contrast incorporated in the initial fertility work-up reduces time to conception and is a cost-effective strategy, the results may lead to adjustments of (inter)national guidelines and change clinical practice. TRIAL REGISTRATION NUMBER The study was retrospectively registered in International Clinical Trials Registry Platform (Main ID: EUCTR2018-004153-24-NL).
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Affiliation(s)
- D Kamphuis
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands.
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - K Rosielle
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - N van Welie
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, 1091 AC, The Netherlands
| | - I Roest
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
- Grow research school for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - A J C M van Dongen
- Department of Obstetrics and Gynaecology, Ziekenhuis Gelderse Vallei, Ede, 6716 RP, The Netherlands
| | - E A Brinkhuis
- Department of Obstetrics and Gynaecology, Meander Medisch Centrum, Amersfoort, 3813 TZ, The Netherlands
| | - P Bourdrez
- Department of Obstetrics and Gynaecology, VieCuri Medisch Centrum, Venlo, 5912 BL, The Netherlands
| | - A Mozes
- Department of Obstetrics and Gynaecology, Ziekenhuis Amstelland, Amstelveen, 1186 AM, The Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, 1091 AC, The Netherlands
| | - D P van der Ham
- Department of Obstetrics and Gynaecology, Martini Ziekenhuis, Groningen, 9728 NT, The Netherlands
| | - F P J M Vrouenraets
- Department of Obstetrics and Gynaecology, Zuyderland Medisch Centrum, Heerlen, 6419 PC, The Netherlands
| | - J J Risseeuw
- Department of Obstetrics and Gynaecology, St. Jansdal Ziekenhuis, Harderwijk, 3844 DG, The Netherlands
| | - T van de Laar
- Department of Obstetrics and Gynaecology, Elkerliek Ziekenhuis, Helmond, 5707 HA, The Netherlands
| | - F Janse
- Department of Obstetrics and Gynaecology, Rijnstate Ziekenhuis, Arnhem, 6815 AD, The Netherlands
| | - J E den Hartog
- Department of Obstetrics and Gynaecology, Maastricht Universitair Medisch Centrum +, Maastricht, 6229 HX, The Netherlands
| | - M de Hundt
- Department of Obstetrics and Gynaecology, Noordwest Ziekenhuisgroep, Alkmaar, 1815 JD, The Netherlands
| | - A B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, 1502 DV, The Netherlands
| | - A G Huppelschoten
- Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Eindhoven, 5623 EJ, The Netherlands
| | - Q D Pieterse
- Department of Obstetrics and Gynaecology, Haga Ziekenhuis, Den Haag, 2545 AA, The Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
- Grow research school for Oncology and Reproduction, Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - J Stoker
- Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands
| | - C A M Koks
- Department of Obstetrics and Gynaecology, Máxima Medisch Centrum, Veldhoven, Eindhoven, 4600 DB, The Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A Hemingway
- Department of Radiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, W12 0HS, England
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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11
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Stewart JK, Hipolito Canario DA, Daso G, Thapa D, Montgomery S, Kohi M. Use of n-Butyl-2-Cyanoacrylate for Fallopian Tube Embolization via Selective Catheterization in a Rabbit Model: Feasibility Study for Potential Nonsurgical Sterilization. J Vasc Interv Radiol 2023; 34:225-233. [PMID: 36306987 DOI: 10.1016/j.jvir.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To determine whether fallopian tube embolization with n-butyl-2-cyanoacrylate (nBCA) administered via a microcatheter in a rabbit model was technically feasible and resulted in short-term tubal occlusion. MATERIALS AND METHODS In 10 female New Zealand white rabbits, the 2 cervices were cannulated using a 5-F catheter and hydrophilic guide wire transvaginally. Salpingography confirmed tubal patency bilaterally. A 2.4-F microcatheter was advanced to the distal fallopian tube, and nBCA/ethiodized oil was administered as the microcatheter was withdrawn to fill the length of the tube. A metallic coil was deployed prior to nBCA administration in half of the fallopian tubes. Rabbits were evaluated for tubal occlusion with salpingography at 1 month, followed by euthanasia and histopathologic analysis. Inflammation and fibrosis were graded from 0 (normal) to 3 (severe). RESULTS Fallopian tube embolization was technically successful in 17 (85%) of 20 fallopian tubes. Thirteen (76%) of 17 embolized fallopian tubes were occluded at 1 month on salpingography (nBCA only, 7/9; nBCA and coil, 6/8). On histopathologic analysis, direct or indirect evidence of occlusion was observed in 14 (82%) of 17 fallopian tubes. Mild or early fibrosis was observed in 65% of the tubes. The mean inflammation and fibrosis scores for the embolized tubes were 0.62 and 0.94, respectively. CONCLUSIONS This pilot study demonstrated that embolization of rabbit fallopian tubes using nBCA administered via a microcatheter is technically feasible and results in occlusion of most fallopian tubes in the short term with minimal inflammation. Investigation of efficacy in preventing pregnancy over the long term is warranted.
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Affiliation(s)
- Jessica K Stewart
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Diego A Hipolito Canario
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gabrielle Daso
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Diwash Thapa
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephanie Montgomery
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Maureen Kohi
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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12
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Moses AS, Kadam L, St Lorenz A, Baldwin MK, Morgan T, Hebert J, Park Y, Lee H, Demessie AA, Korzun T, Mamnoon B, Alani AWG, Taratula O, Myatt L, Taratula OR. Nano-Theranostic Modality for Visualization of the Placenta and Photo-Hyperthermia for Potential Management of Ectopic Pregnancy. Small 2023; 19:e2202343. [PMID: 36394151 PMCID: PMC9839489 DOI: 10.1002/smll.202202343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/26/2022] [Indexed: 05/03/2023]
Abstract
Ectopic pregnancy (EP) is the leading cause of maternity-related death in the first trimester of pregnancy. Approximately 98% of ectopic implantations occur in the fallopian tube, and expedient management is crucial for preventing hemorrhage and maternal death in the event of tubal rupture. Current ultrasound strategies misdiagnose EP in up to 40% of cases, and the failure rate of methotrexate treatment for confirmed EP exceeds 10%. Here the first theranostic strategy for potential management of EP is reported using a near-infrared naphthalocyanine dye encapsulated within polymeric nanoparticles. These nanoparticles preferentially accumulate in the developing murine placenta within 24 h following systemic administration, and enable visualization of implantation sites at various gestational stages via fluorescence and photoacoustic imaging. These nanoparticles do not traverse the placental barrier to the fetus or impact fetal development. However, excitation of nanoparticles localized in specific placentas with focused NIR light generates heat (>43 °C) sufficient for disruption of placental function, resulting in the demise of targeted fetuses with no effect on adjacent fetuses. This novel approach would enable diagnostic confirmation of EP when current imaging strategies are unsuccessful, and elimination of EP could subsequently be achieved using the same nano-agent to generate localized hyperthermia resulting in targeted placental impairment.
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Affiliation(s)
- Abraham S Moses
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Leena Kadam
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Anna St Lorenz
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Maureen K Baldwin
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Terry Morgan
- Department of Pathology and Laboratory Medicine, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Jessica Hebert
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Youngrong Park
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Hyelim Lee
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Ananiya A Demessie
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Tetiana Korzun
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Babak Mamnoon
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Adam W G Alani
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Oleh Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, School of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Olena R Taratula
- Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, 2730 S Moody Avenue, Portland, OR, 97201, USA
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13
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Qu E, Zhang M, Ju J, Chen Y, Lin X, Zhang X. Is Hysterosalpingo-Contrast Sonography (HyCoSy) Using Sulfur Hexafluoride Microbubbles (SonoVue) Sufficient for the Assessment of Fallopian Tube Patency? A Systematic Review and Meta-Analysis. J Ultrasound Med 2023; 42:7-15. [PMID: 35441714 DOI: 10.1002/jum.15988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/27/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to evaluate the diagnostic value of HyCoSy using sulfur hexafluoride microbubbles for fallopian tubal patency assessment in infertile females. Twenty-four studies, including 1358 females with 2661 detected fallopian tubes published from January 2003 to May 2019, were identified. The pooled sensitivity was 93% (95% CI: 90-95%), while the specificity was 90% (95% CI: 87-92%). The area under the receiver-operating characteristic curve was 0.96 (95% CI: 94-98%). The specificity of the four-dimensional HyCoSy subgroup was higher than the 2D/3D subgroup; an increased dose of contrast agent did not affect the specificity, with only a slightly reduced sensitivity.
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Affiliation(s)
- Enze Qu
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Man Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jinxiu Ju
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying Chen
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Lin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinling Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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14
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Castro PT, Aranda OL, Ribeiro G, Araujo Júnior E, Machado AS, Werner H. Fallopian tube: Three-dimensional reconstruction and virtual navigation using microtomography. J Clin Ultrasound 2022; 50:852-853. [PMID: 35599633 DOI: 10.1002/jcu.23242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Pedro Teixeira Castro
- Fetal Medicine Department, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Osvaldo Luiz Aranda
- Department of Obstetrics and Gynecology, Severino Sombra University, Vassouras, Brazil
| | - Gerson Ribeiro
- Department of Arts and Design, Pontifícia Universidade Católica (PUC-Rio), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Alessandra Silveira Machado
- Nuclear Engineering Program (PEN/COPPE), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Heron Werner
- Fetal Medicine Department, Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
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15
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Li R, Qiu X, Chen XF, He M, Wang W, Qiao J, He J, Shi Q. Effects of hysterosalpingo-contrast sonography examination on endometrial receptivity among women with unexplained infertility. Arch Gynecol Obstet 2022; 306:893-900. [PMID: 35635620 DOI: 10.1007/s00404-022-06620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Hysterosalpingo-contrast sonography (HyCoSy) is the preferred method for evaluating fallopian tubal patency, and it is associated with improved rates of natural pregnancy among infertile patients. However, the mechanism underlying the improvement in pregnancy rates following HyCoSy remains unclear. This study aimed to investigate the effect of HyCoSy examination on endometrial receptivity as well as pregnancy rates among infertile women. METHODS This prospective study included 120 women with unexplained infertility who visited our department between June 2018 and February 2021. These patients were classified into the study group (n = 60) and the control group (n = 60) depending on their willingness to undergo three-dimensional HyCoSy in the present cycle (study group) or 6 months later (control group). Endometrial characteristics, including endometrial thickness and pattern as well as the endometrial blood flow distribution pattern, were measured twice by transvaginal Doppler ultrasonography in the preovulatory phase before and after HyCoSy examination. Participants were followed for 6 months to observe the outcome of spontaneous conception. RESULTS Compared with the control group, the study group had a significantly higher cumulative pregnancy rate at 6 months after HyCoSy (21.6% [13/60] vs 5.0% [3/60], P = 0.007). More patients in the study group showed improved endometrial blood flow distribution (P = 0.021, χ2 = 7.699), but no differences in endometrial thickness and pattern were observed between the groups (P > 0.05). CONCLUSION HyCoSy examination may improve endometrial perfusion and has a therapeutic effect on improving spontaneous pregnancy among women with unexplained infertility.
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Affiliation(s)
- Rui Li
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Xia Qiu
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Xiao Fen Chen
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Mei He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Wan Wang
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Jing Qiao
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Jing He
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China
| | - Qi Shi
- Department of Obstetrics and Gynecology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Nanchong, 637000, China.
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16
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Zhang Y, Wang Q, Gao CY, Tian HJ, He WJ, Zhang X, Xiong X. Evaluation of the safety and effectiveness of tubal inflammatory drugs in patients with incomplete tubal obstruction after four-dimensional hysterosalpingo-contrast-sonography examination. BMC Pregnancy Childbirth 2022; 22:395. [PMID: 35525936 PMCID: PMC9080207 DOI: 10.1186/s12884-022-04722-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To investigate the safety and effectiveness of tubal inflammatory drugs in patients with incomplete tubal obstruction of at least one side after four-dimensional hysterosalpingo-contrast-sonography (4D-HyCoSy) examination. METHODS Two hundred fifteen cases of tubal incomplete obstruction were diagnosed by ultrasonography from February 2019 to November 2020.According to retrospective analysis,the patients in this study were divided into experimental and control groups; the experimental group combined with salpingitis drugs, and the control group received blank control. Basic information, degree of pain, postoperative complications, and pregnancy rate were then compared between the two groups. RESULTS Compared with the control group, there was no significant difference in the basic information; in preoperative, intraoperative, or postoperative pain; or in postoperative complications (P > 0.05). The cumulative pregnancy rate of the experimental group (26.8%) was statistically different from that of the control group (14.4%) (P < 0.05). CONCLUSIONS We observed that for infertile patients with incomplete obstruction of at least one fallopian tube as diagnosed by contrast-enhanced ultrasonography, salpingitis-treatment drugs effectively improved the pregnancy rate postoperatively, with high effectiveness and safety. This regimen is thus worthy of further investigation and promotion in the future.
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Affiliation(s)
- Yue Zhang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Qin Wang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Chun-Yan Gao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Hong-Ju Tian
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Wen-Jiao He
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Xi Zhang
- Department of Radiology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China
| | - Xi Xiong
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Army Medical University, Chongqing, 400037, PR China.
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17
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Peters R, Castro PT, Matos APP, Ribeiro G, Lopes Dos Santos J, Araujo Júnior E, Werner H. Virtual segmentation of three-dimensional ultrasound images of morphological structures of an ex vivo ectopic pregnancy inside a fallopian tube. J Clin Ultrasound 2022; 50:535-539. [PMID: 35285030 DOI: 10.1002/jcu.23193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
Ex vivo ultrasound (US) of human tissues has been used for decades on the study of the acoustic physical aspects of the US, to the study of the morphology of the organs. Using three-dimensional (3D) US, we demonstrate the possibilities to study surgical specimens from gynecological conditions. 3D images of the surgical specimen were collected and virtually segmented according to the contrast of its images, providing a 3D image of the ectopic pregnancy and its effects on the fallopian tube.
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Affiliation(s)
- Rafael Peters
- Department of Fetal Medicine, Hospital Bom Pastor, Igrejinha, Brazil
| | | | | | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - Heron Werner
- Biodesign Laboratory DASA / PUC, Rio de Janeiro, Brazil
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18
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Scioscia M, Virgilio BA, Sacchi D, Iaria L, Guerriero S. Fallopian tube entrapped within inflammatory or endometriotic ovarian cyst may mimic malignancy. Ultrasound Obstet Gynecol 2022; 59:399-401. [PMID: 34159672 DOI: 10.1002/uog.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Affiliation(s)
- M Scioscia
- Unit of Gynecological Surgery, Mater Dei Hospital, Bari, Italy
- Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - B A Virgilio
- Department of Obstetrics and Gynecology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - D Sacchi
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padova, Padua, Italy
| | - L Iaria
- Department of Pathology, Policlinico of Abano Terme, Abano Terme, Padua, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy
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19
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Xu Z, Peng C, Lv Y, Sun J, Chen S, Cui A, Jin B. The Performance of Transvaginal Two-Dimensional Fundamental Sonosalpingography Combined with Saline Infusion Pelvic Sonosalpingography for Assessing Fimbrial Part's Morphology and Function of the Fallopian Tubes. J Ultrasound Med 2022; 41:41-50. [PMID: 33656184 DOI: 10.1002/jum.15677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the diagnostic efficacy of transvaginal two-dimensional fundamental sonosalpingography (2D-FS) combined with saline infusion pelvic sonosalpingography (SIPS) for assessing fimbrial part's morphology and function of the fallopian tubes. METHODS One hundred and sixty-nine cases underwent 2D-FS combined with SIPS. Among them, 18 cases received laparoscopy and dye test (LDT) within 3 months after the examination and the results were regarded as reference standard. RESULTS Excluding proximal or middle segment obstructed tubes, the remaining fimbrial parts' display rate by using 2D-FS combined with SIPS was 75.1%. According to the ultrasonic appearance, the fimbrial parts were classified into 4 types: normal, abnormal, suspected abnormal, and unclassifiable. Normal fimbrial parts accounted for 73.8% when the tubes were patent; abnormal fimbrial parts accounted for 74.1% when the tubes were partial obstructed; all became abnormal when the tubes were distal complete obstructed. The fimbrial parts which had been classified by 2D-FS combined with SIPS were compared with LDT further. This combination's accuracy (ACC), sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Youden's index (YI) were 86.4, 87.5, 85.7, 77.8, 92.3, and 0.73%, respectively. The result of consistency analysis showed the combination was essentially consistent with LDT result (Kappa = 0.713). CONCLUSION 2D-FS combined with SIPS can be a preferred method for assessment of the fimbrial part's morphology and function, with its advantages of non-invasive, intuition, and accuracy. This combination could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.
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Affiliation(s)
- Zining Xu
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
- Department of Ultrasound, Zhejiang Provincial TongDe Hospital, Hangzhou, China
| | - Chengzhong Peng
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
| | - Ya'er Lv
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Juan Sun
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shuangxi Chen
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ailin Cui
- Department of Ultrasonography, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Bihui Jin
- Department of Reproductive Endocrinology, Zhejiang Provincial People's Hospital, Hangzhou, China
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20
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Rath A, Priyadarshini B, Mallya V, Khurana N, Tempe A. Melanosis tubae et ovarii: An overlooked entity? INDIAN J PATHOL MICR 2022; 65:187-190. [PMID: 35074993 DOI: 10.4103/ijpm.ijpm_424_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Melanosis is a rare benign entity defined by the deposition of brownish-black pigment in a wide variety of organs especially the gastrointestinal tract, peritoneum, fallopian tubes and ovaries. Melanosis of the fallopian tube is widely known as pigmentosis tubae. Literature has mentioned ovarian teratomas and serous cystadenomas to be associated with the ovarian and peritoneal melanosis. We report five such cases of tubo-ovarian melanosis. The cases include mature teratoma and serous cystadenoma as well as melanosis of the fallopian tubes with otherwise normal ovarian histology. The importance of recognising this entity lies in its differential diagnosis.
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Affiliation(s)
- Ashutosh Rath
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | | | - Varuna Mallya
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Anjali Tempe
- Department of Gynecology and Obstetrics, Maulana Azad Medical College, New Delhi, India
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21
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De Neubourg D, Janssens L, Verhaegen I, Smits E, Mol BW, Roelant E. Live birth after additional tubal flushing with oil-based contrast versus no additional flushing: a randomised, multicentre, parallel-group pragmatic trial in infertile women with at least one patent tube at hysterosalpingo-foam sonography (HYFOIL study). BMJ Open 2021; 11:e054845. [PMID: 34845077 PMCID: PMC8634016 DOI: 10.1136/bmjopen-2021-054845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Tubal patency testing is an essential part in the fertility workup of many subfertile women. Hysterosalpingography (HSG) has long been the test of choice in many clinics. There is evidence from a large randomised multicentre trial and from a recent meta-analysis that women who had HSG using oil soluble contrast medium (OSCM) had higher rates of ongoing pregnancy compared with women who underwent this procedure using water contrast. However, the field is moving away from HSG and nowadays hysterosalpingo-foam sonography (Hyfosy) using ultrasound guidance is considered as the first line office tubal patency test. Therefore, a large multicentre randomised clinical trial (RCT) will be initiated to evaluate if flushing the fallopian tubes with OSCM after a normal Hyfosy showing at least one patent fallopian tube will increase the live birth rate as compared with no flushing. METHODS AND ANALYSIS We plan a multicentre two arm, 1:1 randomised, open-label pragmatic comparative trial in 12 Belgian centres. After informed consent, we will randomise infertile women between 18 and 40 years of age, undergoing Hyfosy as part of the fertility workup to Hyfosy with additional tubal flushing with OSCM versus Hyfosy without additional flushing. Infertility is defined as lack of conception despite 12 months of unprotected intercourse, or three cycles of donor insemination without pregnancy or three ovulatory ovulation induction cycles without pregnancy, all three in combination with at least one patent tube on Hyfosy. Primary endpoint will be live birth with conception within 6 months after randomisation. ETHICS AND DISSEMINATION Approval on 11 May 2021 by the Ethics Committee from ZNA Hospital Antwerp who was the central Ethics Committee for the Clinical Trial Regulation Pilot (Pilot 412) in the 12 centres. The findings from this RCT will be disseminated in peer-reviewed publications and presentations at scientific international meetings. TRIAL REGISTRATION NUMBERS EudraCT number: 2020-002135-30 and NCT04379973.
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Affiliation(s)
- Diane De Neubourg
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Lara Janssens
- Centre for Reproductive Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Iris Verhaegen
- Clinical Trial Centre, Antwerp University Hospital, Edegem, Belgium
| | - Elke Smits
- Clinical Trial Centre, Antwerp University Hospital, Edegem, Belgium
| | - Ben W Mol
- OB/GYN, School of Medicine, Monash University, Clayton VIC, Victoria, Australia
| | - Ella Roelant
- Clinical Trial Centre, Antwerp University Hospital, Edegem, Belgium
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Qiang Y, Wu Y, Cai T. Clinical Significance of Increasing Pressure Curve's Slope When Injecting Ultrasound Contrast Agent During Evaluation of Fallopian Tubal Patency. J Ultrasound Med 2021; 40:2329-2338. [PMID: 33421176 DOI: 10.1002/jum.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the association between Fallopian tubal patency and the slope of the increasing pressure curve for ultrasound contrast agent. MATERIALS AND METHODS A total of 136 patients underwent transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D HyCoSy) between August 2015 and January 2016. We divided the patients into 3 groups according to different Fallopian tubal patency status: 71 patients (48.97%) in bilateral tubal patency group, 45 (31.03%) in unilateral tubal patency group, and 20 in bilateral tubal nonpatent group. The ultrasound contrast agent was injected and the pressure curve was recorded automatically in real time using a liquid-injecting machine that traces it as a pressure curve. The slopes of the different groups are compared through independent sample t test. RESULTS The slopes of the 3 groups were 1.242 ± 0.572, 1.472 ± 0.638, and 2.068 ± 1.236 kPa/s. A correlation was observed between the slope of the increasing pressure curve and tubal patency (R = 0.287, P < .05). The slopes differed significantly between the bilateral tubal patency group and bilateral tubal nonpatent group (P = .001) and between the unilateral tubal patency group and bilateral tubal nonpatent group (P = .012). However, the difference between the bilateral tubal patency and unilateral tubal patency groups was not significant (P = .266). CONCLUSION The increase of the injecting pressure curve's slope for contrast agent during 4D HyCoSy is associated with the nonpatent degree of the tube. This condition can be used as an objective index of tubal patency and can be a reference in diagnosis and treatment.
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Affiliation(s)
- Ye Qiang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Yiyun Wu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Ting Cai
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
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23
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Melcer Y, Gat I, Dvash S, Copel L, Pekar-Zlotin M, Youngster M, Maymon R. Tubal patency assessment using sequential transvaginal ultrasound and hysterosalpingo-foam sonography after methotrexate treatment for tubal pregnancy. Reprod Biomed Online 2021; 44:310-315. [PMID: 34906423 DOI: 10.1016/j.rbmo.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What is the efficacy of sequential two-dimensional transvaginal ultrasound (2D-US) and hysterosalpingo-foam sonography (HyFoSy) after methotrexate (MTX) treatment for tubal pregnancy among patients who desire a future pregnancy? DESIGN A prospective trial conducted between May 2019 and November 2020. Patients who had a suspected tubal ectopic pregnancy diagnosed by ultrasound and treated by MTX were included. These patients underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. The primary outcome was tubal obstruction in the affected side. RESULTS A total of 360 women underwent sequential transvaginal 2D-US assessment of the pelvic organs and a complementary HyFoSy for tubal patency. Of these, 40 (11.1%) women fulfilling the inclusion criteria were enrolled. In six out of 40 (15%), hydrosalpinx of the affected tube was found during the initial transvaginal ultrasound examination and were excluded from further investigation. In the remaining 34 (85%) patients, HyFoSy was carried out. Tubal block was found in 10 out of 34 (29.4%) patients. Of these, eight out of 34 (23.5%) and two out of 34 (5.9%) had a proximal block of the affected tube and bilateral proximal obstruction, respectively. Hysterosalpingography confirmed the tubal obstruction in all the affected cases. No procedure-related complications were documented. CONCLUSIONS Forty per cent of women who were treated by MTX for tubal pregnancy were diagnosed with tubal obstruction. We recommend that sequential transvaginal ultrasound and HyFoSy become part of routine follow-up for these women, thus offering them timely referral to the appropriate specialist.
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Affiliation(s)
- Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel.
| | - Itai Gat
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Shira Dvash
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Laurian Copel
- Department of Radiology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Michal Youngster
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Zerifin 70300, Israel
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Dibbern CB, Bergstrand-Poulsen E, Farooqui W, Penninga L. Internal bowel herniation through a peritoneal defect between the right fallopian tube and right ovarian vessels. BMJ Case Rep 2021; 14:e246171. [PMID: 34620639 PMCID: PMC8499314 DOI: 10.1136/bcr-2021-246171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Waqas Farooqui
- Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Luit Penninga
- Surgery and Transplantation, Rigshospitalet, Copenhagen, Denmark
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25
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Melcer Y, Zilberman Sharon N, Nimrodi M, Pekar-Zlotin M, Gat I, Maymon R. Hysterosalpingo-Foam Sonography for the Diagnosis of Tubal Occlusion: A Systematic Review and Meta-analysis. J Ultrasound Med 2021; 40:2031-2037. [PMID: 33368463 DOI: 10.1002/jum.15607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 12/12/2020] [Indexed: 06/12/2023]
Abstract
This systematic review and meta-analysis evaluated the diagnostic accuracy of hysterosalpingo-foam sonography in suspected cases of tubal occlusion. The combined sensitivity and specificity estimates were 0.99 (95% confidence interval [CI], 0.89-0.99) and 0.91 (95% CI, 0.53-0.98), respectively, with positive and negative likelihood ratios of 11.5 (95% CI, 1.5-87.5) and 0.006 (95% CI, 0.0003-0.12), respectively. The diagnostic odds ratio was 1931.008 (95% CI, 69.7-53,460.8). These findings confirm hysterosalpingo-foam sonography as a highly accurate test for the diagnosis of tubal occlusion and show that it is on a par with standard tests.
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26
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Bolomini G, Moruzzi MC, Moro F, Lavecchia D, Esposito R, Scambia G, Testa AC. Repeat twisting of ovary in young woman with ribbon-like contralateral ovary and absence of contralateral Fallopian tube. Ultrasound Obstet Gynecol 2021; 58:491-492. [PMID: 33206438 DOI: 10.1002/uog.23543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Affiliation(s)
- G Bolomini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Lavecchia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - R Esposito
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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27
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de Matos VL, Pessanha I, David DA, Gante I. Isolated torsion of a fallopian tube: an uncommon cause of abdominal pain in an 11-year-old. BMJ Case Rep 2021; 14:e243947. [PMID: 34433530 PMCID: PMC8388290 DOI: 10.1136/bcr-2021-243947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
This report describes a rare case of isolated fallopian tube torsion (IFTT) in a premenarchal 11-year-old girl. The patient presented with subacute abdominal pain, associated with nausea and vomiting. Sonographic findings revealed left tube enlargement with free intraperitoneal fluid. Doppler mapping was not unequivocal. During exploratory laparoscopy, a large pelvic necrotic mass was found to be a twisted left fallopian tube. After detorsion, salpingectomy was performed and the patient recovered promptly, showing no complications 3 months post operation. IFTT should be considered as a differential diagnosis of lower abdominal pain in adolescent girls with normal-appearing ovaries on ultrasound. Conservative management for fertility preservation is the ideal approach. Therefore, avoiding delay in laparoscopy is crucial.
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Affiliation(s)
- Victória Leones de Matos
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Inês Pessanha
- Department of Pediatric Surgery, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Daniela Agostinho David
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Inês Gante
- Department of gynecology and obstetrics, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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28
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Cordova R, Kiekens K, Burrell S, Drake W, Kmeid Z, Rice P, Rocha A, Diaz S, Yamada S, Yozwiak M, Nelson OL, Rodriguez GC, Heusinkveld J, Shih IM, Alberts DS, Barton JK. Sub-millimeter endoscope demonstrates feasibility of in vivo reflectance imaging, fluorescence imaging, and cell collection in the fallopian tubes. J Biomed Opt 2021; 26:JBO-200404R. [PMID: 34216135 PMCID: PMC8253554 DOI: 10.1117/1.jbo.26.7.076001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/15/2021] [Indexed: 06/13/2023]
Abstract
SIGNIFICANCE Most cases of high-grade serous ovarian carcinoma originate as serous tubal intraepithelial carcinoma (STIC) lesions in the fallopian tube epithelium (FTE), enabling early endoscopic detection. AIM The cell-acquiring fallopian endoscope (CAFE) was built to meet requirements for locating potentially pathological tissue indicated by an alteration in autofluorescence or presence of a targeted fluorophore. A channel was included for directed scrape biopsy of cells from regions of interest. APPROACH Imaging resolution and fluorescence sensitivity were measured using a standard resolution target and fluorescence standards, respectively. A prototype was tested in ex vivo tissue, and collected cells were counted and processed. RESULTS Measured imaging resolution was 88 μm at a 5-mm distance, and full field of view was ∼45 deg in air. Reflectance and fluorescence images in ex vivo porcine reproductive tracts were captured, and fit through human tracts was verified. Hemocytometry counts showed that on the order of 105 cells per scrape biopsy could be collected from ex vivo porcine tissue. CONCLUSIONS All requirements for viewing STIC in the FTE were met, and collected cell counts exceeded input requirements for relevant analyses. Our benchtop findings suggest the potential utility of the CAFE device for in vivo imaging and cell collection in future clinical trials.
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Affiliation(s)
- Ricky Cordova
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Kelli Kiekens
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Susan Burrell
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - William Drake
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Zaynah Kmeid
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Photini Rice
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Andrew Rocha
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Sebastian Diaz
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
| | - Shigehiro Yamada
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Michael Yozwiak
- University of Arizona, Department of Medicine, Tucson, Arizona, United States
| | - Omar L. Nelson
- NorthShore University HealthSystem, Evanston, Illinois, United States
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - Gustavo C. Rodriguez
- NorthShore University HealthSystem, Evanston, Illinois, United States
- University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States
| | - John Heusinkveld
- Banner–University Medical Center, Tucson, Arizona, United States
| | - Ie-Ming Shih
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - David S. Alberts
- University of Arizona, Department of Medicine, Tucson, Arizona, United States
| | - Jennifer K. Barton
- University of Arizona, Department of Biomedical Engineering, Tucson, Arizona, United States
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29
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Chen F, Jain MK, Bhatt S. The "waist sign" of a dilated fallopian tube. Abdom Radiol (NY) 2021; 46:2985-2986. [PMID: 33386918 PMCID: PMC8205892 DOI: 10.1007/s00261-020-02901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/31/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Frank Chen
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Manoj K Jain
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Shweta Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
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30
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Abstract
Fallopian tube obstruction (FTO) is a common cause of female infertility. In the setting of proximal FTO, fallopian tube recanalization (FTR) is a minimally invasive, ambulatory procedure with a technical success rate of up to 100%, with minimal postprocedural adverse events. One-year pregnancy rate following FTR is approximately 41%, with successful delivery of full-term infants in 84% of pregnancies. This minimally invasive, outpatient, image-guided procedure is an alternative to vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) and should be top-of-mind in the setting of infertility due to proximal FTO.
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Affiliation(s)
- Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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31
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Kitami M, Aoki H, Saito M. "Follow the Fallopian tube": A technique to improve sonographic identification of ovaries in children. J Clin Ultrasound 2021; 49:33-37. [PMID: 32827154 DOI: 10.1002/jcu.22906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
Ovary detection is the first step in confirming ovarian lesions. The daughter cyst sign is widely used for this purpose; however, it is not always applicable. Recent improvements in image resolution allow Fallopian tube delineation, which can serve as a guide to identify the ovary. This anatomical approach ("follow the Fallopian tube" technique) comprises three steps: (1) confirm the uterus; (2) follow the Fallopian tube; and (3) find the ovary. Other applications of this approach include the differentiation between nonovarian and ovarian masses and ruling out ovarian torsion and an auto-amputated ovary.
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Affiliation(s)
- Masahiro Kitami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidekazu Aoki
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mioko Saito
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Background It is uncommon to find ampullary tubal pregnancy in the second trimester. Methods A 35-year-old G4P3 at 16 gestational weeks presented with a day history of sudden severe lower abdominal pain and no vaginal bleeding. The patient had a normal pulse of 82/minutes, haemoglobin concentration of 6.3 g/dl and ultrasonography showed an empty uterus with an alive fetus in the right adnexa. She was provisionally diagnosed to have an abdominal pregnancy. Results The patient had an emergency laparotomy where 2.2 L of haemoperitoneum and a slow-leaking right ampullary tubal pregnancy were found. Right total salpingectomy was performed and she had an uncomplicated post-operative follow-up. Histology of the lesion confirmed tubal pregnancy. Conclusion The growth of a pregnancy in the ampulla beyond the first trimester is possibly due to increased thickness and or distensibility of the fallopian tube. A tubal pregnancy may present with a normal pulse despite significant haemorrhage.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynaecology, Klerksdorp Hospital, Klerksdorp, South Africa
| | - Ongombe Lunda
- Department of Obstetrics and Gynaecology, Klerksdorp Hospital, Klerksdorp, South Africa
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Černiauskaitė M, Vaigauskaitė B, Ramašauskaitė D, Šilkūnas M. Spontaneous Heterotopic Pregnancy: Case Report and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56080365. [PMID: 32707853 PMCID: PMC7466362 DOI: 10.3390/medicina56080365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
Heterotopic pregnancy is defined as a condition when intrauterine and extrauterine pregnancy occur simultaneously. It is a life-threatening condition that requires immediate and accurate diagnostics and treatment. We present a case of a 28-year-old primigravida female who conceived spontaneously and at her seventh week of gestation and was presented to the emergency department with weakness and acute pain in lower abdomen. Laboratory tests and transvaginal ultrasonography revealed the diagnosis of heterotopic pregnancy. Urgent laparoscopic salpingotomy was chosen as a treatment option. The ectopic pregnancy was successfully removed with the preservation of the intrauterine embryo and fallopian tubes. The course of pregnancy after the surgery was without complications, and a healthy baby was delivered at the 39th week of gestation. When treated properly and on time, a heterotopic pregnancy can result in live childbirth with favorable outcomes for both the child and the mother.
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Affiliation(s)
- Miglė Černiauskaitė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania
- Correspondence: ; Tel.: +370-622-36-570
| | - Brigita Vaigauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Diana Ramašauskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
| | - Mindaugas Šilkūnas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Clinic of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Clinics, Santariškių g. 2, 08661 Vilnius, Lithuania; (B.V.); (D.R.); (M.Š.)
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Stepniewska AK, Verrazzo P, Savelli L, Trivella G, Signori C, Clarizia R, Guerriero M, Mollo A, De Placido G, Ceccaroni M. Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile. J Minim Invasive Gynecol 2020; 28:63-74. [PMID: 32197993 DOI: 10.1016/j.jmig.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile. DESIGN A single-center, retrospective cohort study. SETTING Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy. PATIENTS A total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle. INTERVENTIONS After the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated. MEASUREMENTS AND MAIN RESULTS The VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%-100%) and 100% (95% CI, 96.3%-100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%-99.5%) and 100% (95% CI, 75.3%-100%), respectively, with specificities of 100% (95% CI, 96.8%-100%) and 100% (95% CI, 96.6%-100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%-100%), 100% (95% CI, 39.8%-100%), and 100% (95% CI, 75.3%-100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%-100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as "less painful than expected," 25% (30 of 120 women) "just as expected," and only 7% (9 of 120 women) as "more painful than expected." CONCLUSION VUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.
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Affiliation(s)
- Anna Katarzyna Stepniewska
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni).
| | - Paolo Verrazzo
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Luca Savelli
- Department of Obstetrics and Gynecology (Dr. Savelli) University of Bologna, Bologna
| | - Giamberto Trivella
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Chiara Signori
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Massimo Guerriero
- Department of Computer Science (Dr. Guerriero), University of Verona, Verona, Italy; Clinical Research Unit (Dr. Guerriero), IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona
| | - Antonio Mollo
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Giuseppe De Placido
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
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Chen LS, Zhu ZQ, Li J, Wang ZT, Qiang Y, Hu XY, Zhang MM, Wang ZQ. Hysterosalpingo-contrast-sonography vs. magnetic resonance-hysterosalpingography for diagnosing fallopian tubal patency: A systematic review and meta-analysis. Eur J Radiol 2020; 125:108891. [PMID: 32088657 DOI: 10.1016/j.ejrad.2020.108891] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare hysterosalpingo-contrast-sonography (HyCoSy) and magnetic resonance-hysterosalpingography (MR-HSG) in the diagnosis of fallopian tubal patency. MATERIALS AND METHODS The databases of PubMed, Embase, and the Cochrane Library were searched for records up to November 30, 2019. Studies involved in the diagnostic detection of HyCoSy or MR-HSG for fallopian tubal patency using conventional HSG or laparoscopy as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (sROC) plots of both HyCoSy and MR-HSG. Quality was assessed using the QUADAS-2 tool. RESULTS The analysis included 24 articles involving 1340 patients. HyCoSy was studied in 17 studies, and MR-HSG was studied in seven studies. For HyCoSy in diagnosis of fallopian tubal patency, pooled sensitivity was 89 % (95 % confidence interval [CI], 87 %-91 %), and specificity was 93 % (95 % CI, 91 %-94 %). For MR-HSG in diagnosis of fallopian tubal patency, pooled sensitivity was 100 % (95 % CI, 98 %-100 %), and specificity was 82 % (95 % CI, 74 %-89 %). The sROC showed similar diagnostic accuracy for MR-HSG and HyCoSy. 3D/4D HyCoSy with ultrasound microbubbles had equal sensitivity (95 % vs. 100 %, P = 0.186) and significantly higher specificity (94 % vs. 82 %, P = 0.005) compared with MR-HSG. CONCLUSIONS HyCoSy and MR-HSG showed similar overall diagnostic performance for diagnosing fallopian tubal patency. 3D/4D HyCoSy with ultrasound microbubbles could significantly improve the diagnostic specificity of HyCoSy.
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Affiliation(s)
- Ling-Shan Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zheng-Qiu Zhu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Jing Li
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zhi-Tao Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Ye Qiang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Xu-Yu Hu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Mei-Mei Zhang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China
| | - Zhong-Qiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, 210029, China.
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Ludwin A, Ludwin I, Szczeklik W, Martins WP. Cutaneous small-vessel vasculitis following hysterosalpingo-foam sonography (HyFoSy). Ultrasound Obstet Gynecol 2019; 54:831-834. [PMID: 31219636 DOI: 10.1002/uog.20372] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 06/09/2023]
Abstract
We present a case of diffuse skin immune reaction, diagnosed as cutaneous small-vessel vasculitis, following assessment of tubal patency by contrast ultrasound, which appears to be the first reported case of hypersensitivity reaction to sonographic tubal patency testing, based on a literature search. A 32-year-old woman presented with non-thrombocytopenic palpable purpura the day after assessment of tubal patency by two-/three-dimensional hysterosalpingo-foam sonography (HyFoSy) using ExEm® Foam. During real-time ultrasound, the observer identified flow in only the right tube when using saline with air as contrast medium; however, the same observer identified flow in both tubes after injecting ExEm Foam and the woman left the clinic without any complications. The next day, the patient was admitted with a complaint of a red-purple skin rash noticed the same morning, associated with moderate leg pain. Slow-motion analysis of the recorded videos and three-dimensional ultrasound datasets showed previously unnoticed venous intravasation of ExEm Foam into the myometrial vessels. Palpable purpura is typically found in vasculitis as a result of extravasation of red cells outside the inflamed blood vessel. This previously unreported side effect of tubal patency testing by HyFoSy, its potential rare organ consequences, as well as unknown consequences of venous intravasation by foam, should be included in the informed consent prior to the examination. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - I Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
- Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - W Szczeklik
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil
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Zhang Q, Xing X, Liu S, Xie X, Liu X, Qian F, Liu Y. Intramural ectopic pregnancy following pelvic adhesion: case report and literature review. Arch Gynecol Obstet 2019; 300:1507-1520. [PMID: 31729562 DOI: 10.1007/s00404-019-05379-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intramural pregnancy is an uncommon type of ectopic pregnancy, where the gestational sac is completely encircled by myometrium and unconnected with endometrial cavity, fallopian tubes or round ligament. Owing to its potentially life-threatening hemorrhage and uterine rupture, early diagnosis and management are urgently required. We present a case of a woman undergoing zigzag medical procedures, which featured non-consensus preoperative diagnosis of intramural and interstitial pregnancy and an intramural ectopic pregnancy ultimately confirmed and successfully removed by emergency laparoscopy. Additionally, we present a review of the related literature and discuss its varied clinical features, imageological characters, diagnosis, differential diagnosis and multiple treatments. METHODS A comprehensive bibliographic search through PubMed, using keywords: intramural ectopic pregnancy. Relevant literatures published from January 2013 to April 2019 were reviewed. RESULTS Twenty-four cases in total for intramural ectopic pregnancy including this report were reviewed. Diagnoses were mainly made by ultrasound images. Most patients had a history of uterine surgery or intrauterine operation and had been surgically resected. None of the mothers were in danger, but only one case had live birth at 37 weeks of gestation. CONCLUSION Non-specific clinical presentation and non-uniform ultrasound criteria pose a challenge for us to make timely and accurate management. Integrated radiological examinations and communication and cooperation between sonographers and gynecologists play a vital role in diagnostic accuracy and selecting the optimal therapeutic method of an intramural pregnancy.
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Affiliation(s)
- Qi Zhang
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiaoxiao Xing
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Shuiqing Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xiao Xie
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xia Liu
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Feng Qian
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yanping Liu
- Department of Medical Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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Waheed KB, Albassam MA, AlShamrani AAG, Aloumi SA, Amin MS, Rashid L, AlGodayan SM, Ahmad SFB. Hysterosalpingographic findings in primary and secondary infertility patients. Saudi Med J 2019; 40:1067-1071. [PMID: 31588489 PMCID: PMC6887874 DOI: 10.15537/smj.2019.10.24538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To highlight and compare spectrum of hysterosalpingography (HSG) findings in primary and secondary infertility patients. Methods: This retrospective record-based cross-sectional study was performed in the Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia between August 2016 and 2018. All patients (N=303) who underwent successful HSGs were included, and grouped under primary and secondary infertility cases. Patients with failed, limited or incomplete studies were excluded. Imaging findings were documented as N (Normal) or Ab (Abnormal). Abnormal HSG findings were further categorized as: C=congenital malformation, I=infection or inflammation, S=surgery, T=tumor or tear. Abnormal findings were confirmed on further imaging or intervention. Chi-square test was used to determine any association of HSG findings with type of infertility, and p-value less than 0.05 was considered significant. Results: Of the 303 patients, 166 patients (54.8%) had primary infertility while the rest had secondary infertility. Abnormal studies were found in less than one-third of patients (n=93, 30.7%). Primary infertility patients exhibited more congenital (C) malformations, while surgery (S) was seen more in secondary infertility patients (p=0.01). Conclusion: Congenital malformations are commonly found abnormalities on HSGs in primary infertility patients, while surgery related findings are seen in secondary infertility cases.
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Affiliation(s)
- Khawaja B Waheed
- Radiology Department, King Fahad Military Medical City, Dhahran, Kingdom of Saudi Arabia. E-mail.
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Shevach Alon A, Kerner R, Ginath S, Barda G, Bar J, Sagiv R. Clinical Characteristics of Women with Isolated Fallopian Tube Torsion Compared with Adnexal Torsion. Isr Med Assoc J 2019; 21:575-579. [PMID: 31542899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Isolated fallopian tube torsion (IFTT) is a rare gynecological entity and its diagnosis is challenging. OBJECTIVES To compare clinical characteristics, sonographic findings, surgical management, and outcomes of women with surgically verified IFTT compared to those diagnosed with adnexal torsion. METHODS A retrospective case-control study in a university hospital was conducted. Thirty-four women with surgically verified IFTT between March 1991 and June 2017 were compared to 333 women diagnosed with adnexal torsion within the same time period. RESULTS Both groups presented primarily with abdominal pain, which lasted longer prior to admission among the IFTT group (46.8 ± 39.0 vs. 30.0 ± 39.4 hours, P < 0.001). Higher rates of abdominal tenderness with or without peritoneal signs were found in the adnexal torsion group (90.3% vs. 70.6%, P < 0.001). Sonographic findings were similar; however, an increased rate of hydrosalpinx was found among the IFTT group (5.9% vs. 0.0%, P = 0.008). Suspected adnexal torsion was the main surgical indication in only 61.8% of IFTT cases compared with 79.0% in the adnexal torsion group (P = 0.02). Salpingectomy with or without cystectomy was more commonly performed in the IFTT group (35.3% vs. 1.5%, P < 0.001). The leading pathological findings among the IFTT group were hydrosalpinx and paraovarian cysts. CONCLUSIONS The clinical signs and symptoms of IFTT and adnexal torsion are similar. Although sonographic imaging demonstrating a paraovarian cyst or hydrosalpinx may be helpful in diagnosing IFTT, it is rarely done preoperatively.
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Affiliation(s)
- Ayala Shevach Alon
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Kerner
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Sagiv
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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He Y, Wu H, Xiong R, Liu H, Shi J, Xu J, Zhang N, Liu Y. Intravasation Affects the Diagnostic Image Quality of Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography With SonoVue. J Ultrasound Med 2019; 38:2169-2180. [PMID: 30597629 DOI: 10.1002/jum.14914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We aim to retrospectively analyze the diagnostic image quality of transvaginal 4-dimensional hysterosalpingo-contrast sonography from infertile patients and determine the significant influencing factors. METHODS A total of 445 patients visiting infertility clinics were included in the study, of which 167 were primary infertile and 278 were secondary infertile. The factors were recorded, including age; examination time; infertility type; history of pelvic inflammatory disease, pelvic surgery, intrauterine surgery, and ectopic pregnancy; endometrial thickness; uterine position; ovarian position; 2-dimensional image quality; intravasation quantity, position, and time; balloon volume; and the dosage of contrast agent or the sterile saline solution. All the factors were compared among different diagnostic image quality groups. The method of rank logistic regression analysis was adopted to analyze the risk factors affecting the diagnostic image quality. RESULTS Among the 445 infertile patients, 124 (27.9%) patients had intravasation occur during transvaginal 4-dimensional hysterosalpingo-contrast sonography. The diagnostic image quality between the 2 sonographers was consistent (Cronbach's alpha, 0.993). Different intravasation quantities, positions, and times; increased of balloon volume; and history of pelvic surgery were substantial risk factors for the diagnostic image quality. The diagnostic image quality diminished with the increase of intravasation. In the patient with cornual intravasation, the diagnostic image quality was substantially worse than that with non-cornual intravasation. Moreover, early onset of intravasation seriously affected the diagnostic image quality. CONCLUSIONS In conclusion, intravasation affected the diagnostic image quality, especially early cornual massive intravasation.
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Affiliation(s)
- Yanni He
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Haorong Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ran Xiong
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Hongmei Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jiayao Shi
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Jingjiao Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Ning Zhang
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
| | - Yu Liu
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Ultrasonography, Guangdong Second Provincial General Hospital, Guangdong, China Zhujiang Hospital, Southern Medical University, Guangzhou (H.L.)
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Exalto N, Emanuel MH. Clinical Aspects of HyFoSy as Tubal Patency Test in Subfertility Workup. Biomed Res Int 2019; 2019:4827376. [PMID: 31360713 PMCID: PMC6644241 DOI: 10.1155/2019/4827376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/04/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Tubal patency testing is an essential part of female subfertility evaluation. Traditionally, hysterosalpingography (HSG) was the first step to evaluate tubal patency. However, during the past decade Hysterosalpingo-Contrast Sonography (HyCoSy) was introduced in order to avoid radiation exposure and Hysterosalpingo-Foam Sonography (HyFoSy) has been developed as a safe and less painful alternative. OBJECTIVES AND RATIONALE The aim of this narrative review is to provide an overview of the currently available HyFoSy literature and related clinical aspects. SEARCH METHODS A literature search was conducted using PubMed and Embase from the introduction of HyFoSy to March 2019. Unfortunately, a meta-analysis was not possible due to a too small number of studies, being mutually incomparable for the various subjects of clinical aspects, even for the reliability as a test for tubal patency. OUTCOMES Nine small studies concluded that the accuracy and effectiveness as a test for tubal patency of 2D- and 3D-HyFoSy are comparable or even better than HSG or HyCoSy. With or without using Doppler techniques, 3D-HyFoSy does not seem to offer benefits above real-time 2D-HyFoSy. Five studies reported on pain and discomfort during HyFoSy, concluding that HyFoSy is a well-tolerated, less painful procedure compared to HSG, without a need for the use of analgesics. There are suggestions about an increased pregnancy rate in the first three cycles after the procedure but in no studies pregnancy outcome after HyFoSy was compared with other or no intervention. WIDER IMPLICATIONS HyFoSy is a promising and safe alternative for HSG with regard to accuracy and effectiveness. HyFoSy lacks radiation and iodine exposure and is a well-tolerated and less painful procedure than HSG, without the need for analgesics. However more research is needed to make clear statements regarding a therapeutic effect of HyFoSy.
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Affiliation(s)
- Niek Exalto
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Mark Hans Emanuel
- Division of Woman and Baby, Department of Gynaecology and Reproductive Medicine, University Medical Centre, Utrecht, Netherlands
- Department of (Uro)gynaecology, University Hospital, Ghent, Belgium
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Abstract
Background Prior studies on Hysterosalpingography (HSG) have shown that pelvic inflammatory disease (PID) related tubal adhesions accounted for 30 – 50% of female infertility, with as high as 80% reported in some studies. With improved access to contraceptives, antibiotics and promotion of safe practices, the abnormal findings in HSG may have reduced or altered. Objective To document the imaging findings in the HSG of participants and to compare current findings with prior studies done nationally and internationally. Method A retrospective evaluation of 974 HSGs done at the tertiary diagnostic center over a 7-year period was conducted and analyzed using diagnostic accuracy tables. Results Tubal pathologies were the most common abnormality in this study, (35.1% of the cases), comprising tubal blockage and hydrosalpinges; followed by uterine masses seen in 223 (22.9%) of the clients. Tubal occlusion was higher in clients with multiple abnormal findings; while normal sized and large uterine cavities had a higher percentage of bilateral tubal patency. Conclusion Tubal factors remain the most common abnormality seen in the HSGs of infertile women in this study, though with lower prevalence compared with prior older studies. Forty seven (47%) of the cases of female factor infertility had normal HSGs with bilateral tubal patency.
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Affiliation(s)
- Olubukola AT Omidiji
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi-Araba, Lagos
| | | | - Omololu Adegbola
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos
| | | | - Omodele A Olowoyeye
- Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiography, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Idi-Araba, Lagos
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Abstract
"To understand the actual world as it is, not as we should wish it to be, is the beginning of wisdom." - Bertrand Russell.
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Affiliation(s)
- Eve C Feinberg
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Carretti M, Dos Santos Simões R, Bernardo WM, Pinheiro W, Pereira AKC, Baracat MCP, Soares Junior JM, Baracat EC. Accuracy of Ultrasonography in the Evaluation of Tubal Sterilization Microinsert Positioning: Systematic Review and Meta-analysis. J Ultrasound Med 2019; 38:289-297. [PMID: 30051486 DOI: 10.1002/jum.14714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
The current reference standard to check the position of a tubal sterilization microinsert device after its insertion is hysterosalpingography. The objective of this study was to evaluate the accuracy of 2-dimensional (2D) and 3-dimensional (3D) ultrasonography (US) in the positioning of the tubal sterilization microinsert for definitive contraception. We searched MEDLINE, Embase, Cochrane, and Scopus databases through October 2017. Selection criteria included studies that analyzed the accuracy of 2D or 3D US, or both, with respect to the positioning of the microinsert. Data were displayed as forest plots and a summary receiver operating characteristic curves. Values for sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated. The pooled analysis produced sensitivity and specificity values for 2D US in the positioning of the microinsert of 0.88 (95% confidence interval [CI], 0.47-1.0) and 0.92 (95% CI, 0.88-0.95), respectively, with positive and negative LRs of 8.68 (95% CI, 1.63-46.1) and 0.35 (95% CI, 0.11-1.11), respectively. Three studies analyzed the performance of 3D US, showing sensitivity, specificity, and positive and negative LRs of 0.75 (95% CI, 0.35-0.97), 0.82 (95% CI, 0.77-0.87), 3.65 (95% CI, 2.31-5.75), and 0.46 (95% CI, 0.2-1.09). In conclusion, 2D and 3D US are methods that show good accuracy in tubal sterilization microinsert positioning.
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Affiliation(s)
- Mayra Carretti
- Gynecology Discipline, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo Dos Santos Simões
- Gynecology Discipline, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Walter Pinheiro
- Gynecology Discipline, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - José Maria Soares Junior
- Gynecology Discipline, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edmund Chada Baracat
- Gynecology Discipline, Clinics Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
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Xia LF, Ye S, Shen XX, Tang J, Yang HJ, Huang Y. Primary leiomyosarcoma of the fallopian tube: Three case reports and review of the literature. Taiwan J Obstet Gynecol 2018; 57:456-461. [PMID: 29880185 DOI: 10.1016/j.tjog.2018.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Leiomyosarcoma of the fallopian tube is a rare malignant gynecologic neoplasm with poor prognosis. It is important to share experience and to collect more cases to improve the understanding of the disease. CASE REPORT We reported three patients with leiomyosarcoma of the fallopian tube who were treated in Fudan University Shanghai Cancer Center (Shanghai, China) from 2012 to 2016. Although the three cases shared the same diagnosis, they varied in the presentations, treatments, and outcomes. CONCLUSION Leiomyosarcoma of the fallopian tube seems to have some particularities in imaging manifestations and immunohistochemical results. It has a progressive course with limited therapeutic options such as surgery, chemotherapy or radiotherapy.
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Affiliation(s)
- Ling-Fang Xia
- Department of Gynecologic Oncology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Shuang Ye
- Department of Gynecologic Oncology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Xu-Xia Shen
- Department of Pathology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Jia Tang
- Department of Gynecologic Oncology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Hui-Juan Yang
- Department of Gynecologic Oncology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China
| | - Yan Huang
- Department of Gynecologic Oncology, Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China.
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Wang W, Zhou Q, Zhou X, Chen Z, Zhang H. Influence Factors on Contrast Agent Venous Intravasation During Transvaginal 4-Dimensional Hysterosalpingo-Contrast Sonography. J Ultrasound Med 2018; 37:2379-2385. [PMID: 29637586 DOI: 10.1002/jum.14594] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). METHODS The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. RESULTS In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. CONCLUSIONS Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.
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Affiliation(s)
- Weiqun Wang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qiulan Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xingxing Zhou
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhiyi Chen
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hui Zhang
- Department of Ultrasound Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Raban O, Zilber H, Hadar E, Efrat Z, Krissi H, Wiznitzer A, Meizner I, Bardin R. Isolated Fallopian Tube Torsion: A Unique Ultrasound Identity or a Serial Copycat? J Ultrasound Med 2018; 37:2387-2393. [PMID: 29573346 DOI: 10.1002/jum.14595] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report the preoperative ultrasound (US) signs of isolated fallopian tube torsion in surgically verified cases and to estimate whether preoperative US detection of this condition can be improved. METHODS The charts of 27 women with a surgical diagnosis of isolated fallopian tube torsion at a tertiary medical center from 2005 to 2016 were retrospectively reviewed. Data were collected from the electronic database of the US unit and compared with the surgical findings. RESULTS Isolated fallopian tube torsion was correctly diagnosed by US before surgery in 8 of the 27 women (29.6%). In the remainder, the US signs were attributed to torsion of the ovary or the entire adnexa (n = 13), or no torsion was suspected (n = 6). Fallopian tube edema was listed as a US finding in 7 patients, of whom 5 had a correct diagnosis of isolated fallopian tube torsion. The presence of a paraovarian cyst concomitant with normal-appearing ovaries was assumed by US in 5 of the 8 cases that were accurately diagnosed as isolated fallopian tube torsion. The most misinterpreted US finding was an ovarian cyst (suspected in 10 patients and verified at surgery in 2). Absence of blood flow was described in 12 women, of whom 5 had an accurate diagnosis of isolated fallopian tube torsion. Six of the patients with a correct US diagnosis were adults (37.5% of total adults), and 2 were adolescents (18.2% of total adolescents). CONCLUSIONS The US diagnosis of isolated fallopian tube torsion is challenging. A high index of suspicion is necessary to improve its detection, especially when there are possible US signs of torsion in the presence of a normal-appearing ovary.
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Affiliation(s)
- Oded Raban
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Zilber
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Efrat
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Wiznitzer
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Meizner
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Bardin
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rosič M, Žegura B, Vadnjal Đonlagić S. Use of Hysterosalpingo-Foam Sonography for Assessment of the Efficacy of Essure Hysteroscopic Sterilization. J Ultrasound Med 2018; 37:1929-1935. [PMID: 29344973 DOI: 10.1002/jum.14539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Hysterosalpingo-foam sonography (HyFoSy) has been suggested to be a possible less invasive alternative to hysterosalpingography (HSG), which is the reference standard for confirmation of tubal occlusion after Essure (Bayer AG, Leverkusen, Germany) hysteroscopic sterilization. The purpose of our study was to evaluate the accuracy of HyFoSy compared to HSG for confirmation of tubal occlusion after Essure hysteroscopic sterilization. METHODS A prospective study included 90 patients who underwent Essure hysteroscopic sterilization. Twelve weeks after the sterilization, 2-dimensional transvaginal ultrasonography was performed to assess the microinsert position and was followed by HyFoSy and HSG for evaluation of tubal occlusion. Patients with patent fallopian tubes on HSG were scheduled for additional HSG procedures at 3-month intervals until tubal occlusion was documented. RESULTS Of 90 enrolled patients, 86 patients with 170 fallopian tubes underwent the complete imaging protocol. Tubal occlusion was evaluated by HyFoSy as an index test and HSG as a reference standard. The accuracy of HyFoSy was 97.1% (95% confidence interval [CI], 93%-99%). The sensitivity and specificity were 100% (95% CI, 97%-100%) and 54.6% (95% CI, 23%-83%), whereas the positive and negative predictive values were 97.0% (95% CI, 93%-99%) and 100% (95% CI, 42%-100%), respectively. No long-term complications were reported for HyFoSy or HSG. CONCLUSIONS Given that the concordance rate for tubal occlusion between HyFoSy and HSG was not 100%, an occluded fallopian tube on HyFoSy should be confirmed by HSG, which remains the reference standard for confirmation of tubal occlusion after Essure hysteroscopic sterilization.
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Affiliation(s)
- Maja Rosič
- Departments of General Gynecology and Gynecologic Urology, University Medical Center Maribor, Maribor, Slovenia
| | - Branka Žegura
- Departments of General Gynecology and Gynecologic Urology, University Medical Center Maribor, Maribor, Slovenia
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Zhang Q, Liu A, Wu JJ, Niu M, Zhao Y, Tian SF, Chen A, Zhong L. Primary malignant mixed Müllerian tumors of the fallopian tube with cervix metastasis: A rare case report and literature review. Medicine (Baltimore) 2018; 97:e11311. [PMID: 29995765 PMCID: PMC6076084 DOI: 10.1097/md.0000000000011311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
RATIONALE Primary malignant mixed mullerian tumors of the fallopian tube is very rare and has only 1 case in the current literature with cervix metastasis. PATIENT CONCERNS We reported a 49-year-old woman sufferring from primary malignant mixed mullerian tumors of the fallopian tube with cervix metastasis, and the imaging examination found a strip of solid mass in the right fallopian tube and a nodular mass in cervical canal, which were both hyperintense on T2 weighted image (T2WI) and diffusion weighted image (DWI) and continuous moderate enhancement on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DIAGNOSES The diagnosis was confirmed according to the specific anatomical location and pathological examination which was proved as primary malignant mixed mullerian tumors of the fallopian tube with cervix metastasis. INTERVENTIONS The patient underwent radical hysterctomy, bilateral adnexectomy, pelvic lymph node dissection, omentum majus excision and intravenous chemotherapy. OUTCOMES Her posttreatment condition was good. LESSONS Primary malignant mixed mullerian tumors of the fallopian tube can be located by magnetic resonance image examination, which may also offer several diagnostic tips according to changes in signal and enhancement. When combined with pathological findings, qualitative diagnosis can be determined. Surgery and adjuvant chemotherapy are considered as effective methods. Our paper discussed its epidemiology, clinical symptoms, pathologic characters, therapeutic method as well as magnetic resonance imaging findings suggesting the diagnosis and differential diagnosis, including precontrast scan, contrast scan and diffusion weighted image and provided magnetic resonance imaging characteristics of primary malignant mixed mullerian tumors of the fallopian tube described in other literatures.
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Michael Straughn J, Boitano T, Smith HJ, Dilley SE, Liang MI, Novak L. Treatment of low-grade endometrial stromal sarcoma in a nulligravid woman. Gynecol Oncol 2018; 151:6-9. [PMID: 29887484 DOI: 10.1016/j.ygyno.2018.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 32 year-old nulligravid woman with a uterine mass underwent exploratory laparotomy with myomectomy. Final pathology revealed a low-grade endometrial stromal sarcoma (ESS) with positive margins. She subsequently underwent definitive robotic hysterectomy and bilateral salpingectomy with ovarian preservation. She was diagnosed with a stage IB low-grade ESS. She is currently undergoing observation. Discussion of classification, surgical options, and adjuvant therapy is presented.
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Affiliation(s)
- J Michael Straughn
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States.
| | - Teresa Boitano
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Haller J Smith
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Sarah E Dilley
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Margaret I Liang
- University of Alabama at Birmingham, Division of Gynecologic Oncology, United States
| | - Lea Novak
- University of Alabama at Birmingham, Department of Pathology, United States
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