Francisco Salazar

Variables that predict the success of labor induction

Background.  To analyze the clinical and sonographic variables that affect the success of labor induction.

Hysteroscopic Dynamic Assessment of the Endometrium in Patients Treated with Long-Term Tamoxifen

STUDY OBJECTIVE To describe the evolutive endometrial hysteroscopic patterns in patients undergoing long-term tamoxifen treatment. DESIGN Prospective analysis. Analysis of variance test with post hoc Bonferroni test and homogeneity test of percentages were used for hypothesis contrast between the groups. DESIGN CLASSIFICATION Canadian task force II-2. SETTING Four Spanish tertiary care hospitals. PATIENTS A total of 278 patients with breast cancer diagnosed between 2002 and 2004, which completed 5-years adjuvant therapy with tamoxifen. INTERVENTIONS Ultrasonography and hysteroscopic explorations were performed before starting the treatment and then at yearly intervals during the 5 years of adjuvant treatment. MEASUREMENTS AND MAIN RESULTS Hysteroscopic endometrial changes were significant throughout the years of treatment. Tamoxifen-exposed endometria present five different patterns: atrophic, cystic, hypervascularized, endometrial polyp, and suspicious of malignancy. Endometrial carcinoma appeared in four patients (1.5%) that bled during the follow-up. CONCLUSION Tamoxifen produces five different endometrial patterns that evolve dynamically throughout the 5 years of treatment.

Periovulatory follicular volume and vascularization determined by 3D and power Doppler sonography as pregnancy predictors in intrauterine insemination cycles

To evaluate the relationship between volume and vascularization of the periovulatory follicle and subfollicular area measured by three‐dimensional power Doppler ultrasound (US), and ovulation and pregnancy in patients undergoing intrauterine insemination (IUI).

Valoración ecográfica del endometrio en pacientes tratadas con tamoxifeno

Objetivo: Medir el grosor y caracterizar las imagenes ecograficas del endometrio inducidas por tamoxifeno y conocer su evolucion durante el tratamiento. Pacientes y metodos: Analizamos 278 pacientes con cancer de mama, entre 1995 y 2000, en tratamiento adyuvante con tamoxifeno durante 5 anos, explorandolas mediante ecografia transvaginal anual. Realizamos un analisis retrospectivo del grosor endometrial y de los patrones morfologicos endometriales reflejados en las imagenes ecograficas archivadas. Resultados: El grosor endometrial aumenta significativamente en los anos de tratamiento; pasa de 7,84 mm de media el primer ano a 16,67 mm el quinto ano. Existen 5 patrones ecograficos endometriales en las pacientes tratadas con tamoxifeno: lineal, heterogeneo-hiperrefringente, homogeneneo-hiperrefringente, patron de polipo endometrial y patron sospechoso de malignidad. El primer ano predomina el patron homogeneo-hiperrefringente y el ultimo ano, el patron heterogeneo-hiperrefringente. Conclusiones: El tamoxifeno aumenta el grosor endometrial en los anos de tratamiento e induce 5 patrones ecograficos que cambian ano a ano.

Postmenopausal Persistent Unilocular Ovarian Formations are not Risk Factor for Ovarian Carcinoma. A Long-Term Follow-Up Cohort Study

Objective: To assess the potential for malignancy in ultrasonographic low-score persistent ovarian formations in postmenopausal women. Methods: In the Department of Gynecology of a University Hospital, an expectant management was offered to a cohort of 86 postmenopausal patients with unilocular persistent ovarian formations between 50 and 100 mm diameter. After informed consent, they were prospectively followed by means of transvaginal ultrasonography and CA 125 serum measurement annually for 9 years. Results: Of the 86 women, 41 (47.6%) had no changes in ovarian cyst diameter (mean diameter 69 mm, range 52-95) or CA 125 serum concentrations in the follow-up period. In 24 women (27.9%), the cyst disappeared between different follow-up visits. 21 patients (24.4%) underwent surgery for any reason and the ovaries were resected. No ovarian malignancy was diagnosed in any case in our series. Conclusion: Consistent with our hypothesis, follow up with transvaginal sonography and serum CA 125 measurement is not strictly necessary in postmenopausal patients with unilocular ovarian formations between 50 and 100 mm diameter.

Anatomopathologic Subtypes of Endometrial Carcinoma: Case-Control Study of 122 Cases. Epidemiology and Ultrasound

Objective To determine the epidemiological and sonographic characteristics of patients with endometrial carcinoma of endometrioid and non-endometrioid subtype to analyse if any differences can be observed between the groups. Study design A case-control study was performed considering 122 patients with endometrial carcinoma where 96 (78.69%) had endometrioid carcinomas (controls) and 26 (21.31%) had non-endometrioid carcinomas (cases). Epidemiological, clinical, and sonographic variables (endometrial thickness and sonographic suspicion of myometrial invasion of the tumour) were analysed. Qualitative variables were studied with the Chi-square test and the Fishers exact test and quantitative variables with the t test. A value of p < 0.05 was considered statistically significant. Results Tumours of the non-endometrioid type are observed in older patients (p = 0.003) and frequently show a higher sonographic tumoral invasion (p = 0.0036). Conclusions This study supports previous observations that non-endometrioid endometrial carcinomas present at older ages and provides new data that non-endometrioid carcinoma more frequently show sonographic images compatible with myometrial invasion.