Manuel García-Manero

Sonographic Features of Ovarian Cystadenofibromas Spectrum of Findings

To describe the sonographic characteristics of ovarian cystadenofibromas.

Transvaginal color Doppler imaging in the detection of ovarian cancer in a large study population.

Introduction: The aim of the study was to compare the diagnostic accuracy of grayscale sonography and that of color Doppler imaging in the diagnosis of ovarian malignancy in a prospective study by the Sardinia-Navarra group. Methods: The study was performed as a collaborative work at the 2 European university departments of obstetrics and gynecology between 1997 and 2007. A total of 2148 pelvic masses in 1997 women on whom transvaginal sonography were performed before surgical exploration were included in the study. An adnexal mass was first studied in grayscale sonography, and any cystic mass in which the echo architecture was not suggestive of benign tumor was categorized as malignant. Second, any solid excrescences or solid portions of the tumor were evaluated with color/power Doppler sonography. A mass was graded malignant if flow was shown within the excrescences or the solid areas and benign if there was no flow or if flow was only peripheral. Results: Four hundred sixty-eight masses were malignant. Color Doppler evaluation was more accurate in the diagnosis of adnexal malignancies in comparison with grayscale sonography because of a significantly higher specificity (94% vs 89%, P = 0.001), with similar sensitivity (95% vs 98%, P = 0.44). The pretest probability of ovarian cancer was 22%, and this probability rose to 82% when the diagnosis was suggested by color Doppler evaluation. The diagnostic accuracy of the tests was also dependent on menopausal status. Conclusions: The evaluation of vessel distribution by color Doppler sonography in adnexal masses increases the diagnostic accuracy of grayscale sonography in the detection of adnexal malignancies in a large study population.

Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound‐based scoring system

To prospectively evaluate an ultrasound‐based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.

Three-Dimensional Sonographic Morphologic Assessment of Adnexal Masses A Reproducibility Study

The purpose of this study was to assess the reproducibility of 3‐dimensional (3D) sonography for classifying adnexal masses.

Transvaginal Color Doppler Sonography Versus Sonohysterography in the Diagnosis of Endometrial Polyps

Objective. To compare the diagnostic performance of transvaginal color Doppler sonography (TVCD) and sonohysterography (SHG) in the diagnosis of endometrial polyps. Methods. Fifty‐one women (mean age, 51 years; range, 27–75 years) with clinical or B‐mode sonographic suspicion of endometrial polyps were included in this prospective study. Transvaginal color Doppler sonography first and then SHG were performed in all patients. On TVCD, a polyp was suspected when a vascular pedicle penetrating the endometrium from the myometrium was identified. On SHG, a polyp was suspected when a focal polypoid lesion was seen within the endometrial cavity. All patients underwent hysteroscopy and endometrial biopsy, the findings of which were used as the criterion standard. Sensitivity and specificity for TVCD and SHG were calculated and compared by the McNemar test. Results. Hysteroscopy and endometrial biopsy findings were as follows: endometrial polyps, 41; endometrial hyperplasia, 3; cystic atrophy, 4; proliferative endometrium, 2; and endometritis, 1. Sensitivity and specificity for TVCD and SHG were 95% and 80% and 100% and 80%, respectively (McNemar test, P = .5) Conclusions. Transvaginal color Doppler sonography and SHG had similar performance for diagnosing endometrial polyps.

Postpartum ovarian vein thrombosis after cesarean delivery: a case report

IntroductionPostpartum ovarian vein thrombosis is an uncommon complication; incidence varies between 0.002% and 0.05%. It most often occurs during the 2–15 days following delivery.Case presentationA 22-year-old pregnant woman at term presented to hospital with uterine contractions, abdominal pain, nausea and vomiting. After delivery an ovarian vein thrombosis was diagnosed.ConclusionLow-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis.

The value of minilaparotomy for total hysterectomy for benign uterine disease: A comparative study with conventional Pfannenstiel and laparoscopic approaches

Background The aim of this paper is to review and compare the results obtained using the Pfannenstiel, laparoscopy and minilaparotomy approaches for total hysterectomy procedure in relation to benign uterine diseases. Methods A retrospective data analysis was performed on 165 patients who underwent hysterectomy for benign uterine diseases at our centre during the period 2004 to 2006. Findings The minilaparotomy procedure was the fastest procedure with a mean time of 73.4 minutes (range: 67.85 to 78.94 minutes, p < 0.001). Hospital stay was shortest for laparosopic procedure (mean time: 3.24 days, range: 2.86 to 3.61 days) (p < 0.001). The rate of intraoperative and postoperative complications were not statistical different among three procedures. Conclusion The minilaparotomy procedure offers a minimally invasive option for total hysterectomy due to benign uterine disease.

Different injection sites of radionuclide for sentinel lymph node detection in breast cancer: single institution experience.

OBJECTIVE The sentinel node is defined as the first lymph node in a regional basin that receives lymph flow from the primary tumor. There is still a controversy over deep versus superficial injection administration in the breast. STUDY DESIGN From June 2006 to June 2008, 133 patients with biopsy proven breast carcinoma and clinically negative axilla have been treated with conservative surgery and a study of their axillary sentinel lymph nodes (SLN) has been conducted. RESULTS The median number of SLN detected was significantly higher in the periareolarly injected (PA) group (2.43) than in the intratumorally injected (IT) group (1.92) (p=0.008). The incidence of positive SLN in the PA group was not significantly different from the incidence observed in the IT group (p=0.22). CONCLUSION Both techniques seem to reliably identify the true SLN in the axilla. Although intradermal as compared with intratumoral injection has numerous advantages, including ease of injection, shorter time between injection and sentinel node identification, and increased radiotracer nodal uptake, nevertheless, intradermal injection allows almost exclusive identification of axillary nodes, and only on rare occasions, of non-axillary nodes. We therefore think that intratumoral injection must be preferred to intradermal when possible to identify the node that is the first draining step of the tumoral tissue.

Relationship between Microvascular Density and Expression of Vascular Endothelial Growth Factor in Patients with Ovarian Endometriosis

OBJECTIVE The aim of this investigation was to assess whether a correlation exists among microvascular density (MVD), expression of endothelial growth factor, and pelvic pain in patients with ovarian endometriosis. METHODS Sixty-five patients (mean age 33.3 years, range 20-49 years) were diagnosed as having suspected cystic ovarian endometriosis and were scheduled for surgery. Patients were classified into two groups according to clinical complaints: group A, asymptomatic patients or patients with mild dysmenorrhea, and group B patients with severe dysmenorrhea and/or chronic pelvic pain and/or dispareunia. Immunohistochemical staining for CD34 and vascular endothelial growth factor (VEGF) in histological specimens for MVD and VEGF cellular expression assessment were performed. RESULTS Five patients were excluded after surgery because no ovarian endometriosis was found in histological analysis. Thirty women were included in each group. MVD was higher in the symptomatic group. No differences were found in VEGF cellular expression. CONCLUSIONS We conclude that pain symptoms in ovarian endometriosis are directly correlated with MVD but not with VEGF cellular expression. Based on our results, it appears that in endometriotic cysts, the angiogenic processes are present but not completely mediated by VEGF.

Transvaginal ultrasound in the diagnosis of uterine pathology

Uterine pathology represents one of the most common sources of complaints in women. It may cause pelvic pain, abnormal uterine bleeding or problems related to infertility. On the other hand, endometrial cancer is the most common gynecologic malignancy. Pelvic ultrasound has been demonstrated as an excellent tool for diagnosing uterine pathology. In this review, we shall summarize the role of this technique for diagnosing uterine pathologies, such as uterine congenital anomalies, myoma and sarcoma, adenomyosis, benign endometrial pathology and endometrial cancer. We shall also address new technologies, such as 3D ultrasound, and the future prospects of this ever-evolving technique.