Pedro Royo

Intraobserver and Interobserver Reproducibility of 3-Dimensional Power Doppler Vascular Indices in Assessment of Solid and Cystic-Solid Adnexal Masses

The purpose of this study was to assess the intraobserver and interobserver reproducibility of 3‐dimensional (3D) power Doppler angiography–derived vascular indices in evaluation of vascularized solid and cystic‐solid adnexal masses.

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.

Endometriosis in a postmenopausal woman without previous hormonal therapy: a case report

IntroductionThe prevalence of pelvic endometriosis is high, affecting approximately 6% to 10% of women of reproductive age. Although endometriosis has been associated with the occurrence of menstrual cycles, it can affect between 2% to 5% of postmenopausal women.Case presentationWe present a case of ovarian endometriosis in a 62-year-old Spanish Caucasian woman with no previous use of hormonal therapy and no history of endometriosis or infertility.ConclusionAlthough the reported situation is rare, it is important to be aware of endometriosis after the menopause: post-menopausal endometriosis confers a risk of recurrence and malignant transformation.

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.

Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: a case report

IntroductionAn imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation.Case presentationA 33-year-old woman (G3, P3) presented referring intense dysmenorrhea and intermenstrual spotting since her third cesarean delivery, 1 year before. A cesarean section dehiscence with utero-peritoneal fistula was diagnosed by transvaginal ultrasound.ConclusionWe can conclude that transvaginal two-dimensional power Doppler and three-dimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.

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.

Three-dimensional power Doppler assessment of uterine vascularization in women with primary dysmenorrhea.

Objective. The aim of this study was to assess myometrial vascularization with 3‐dimensional (3D) power Doppler angiography (PDA) in women with different grades of primary dysmenorrhea at the moment of maximum menstrual pain in an effort to improve the pathophysiologic knowledge of one of the most common gynecologic conditions. Methods. This was a cross‐sectional study involving 70 voluntary women that studied or worked at the Clinica Universitaria de Navarra between January 2006 and January 2008. All women underwent transvaginal sonographic 3D PDA on the day of maximum pain after the onset of menstruation or during the first 24 to 48 hours of the new cycle if no pain was present. Three groups were defined according to a visual analog scale: no pain to mild dysmenorrhea, moderate dysmenorrhea, and severe dysmenorrhea. Vascularity assessment was done on the basis of 3D vascularity indices: the vascularization index (VI), flow index (FI), and vascularization‐flow index (VFI). Results. The mean VI and VFI for the inner 5 mm of the myometrium and the total myometrium were significantly higher in the women with severe dysmenorrhea than in those with no pain to mild dysmenorrhea (P < .05). The VI, FI, and VFI in the women with moderate dysmenorrhea did not differ significantly from those in the women with severe dysmenorrhea. Conclusions. This study evaluated the use of 3D PDA for assessing uterine and specifically myometrial vascularization. Our data indicate that women with severe dysmenorrhea have increased myometrial vascularization during the early menstrual phase compared with women without pain.

B‐mode and Doppler features of struma ovarii

1. Lack EE. Extragonadal germ cell tumors of the head and neck region: review of 16 cases. Hum Pathol 1985; 16: 56–64. 2. Washburne JF, Magann EF, Chauhan SP, Fratkin JD, Morrison JC. Massive congenital intracranial teratoma with skull rupture at delivery. Am J Obstet Gynecol 1995; 173: 226–228. 3. Narda A, Schut L, Sutton L. Congenital forms of intracranial teratoma. Child Nerv Syst 1991; 7: 112–114. 4. Im SH, Wang KC, Kim SK, Lee YH, Chi JG, Cho BK. Congenital intracranial teratoma: prenatal diagnosis and postnatal successful resection. Med Pediatr Oncol 2003; 40: 57–61. 5. Wakai S, Arai T, Nagai M. Congenital brain tumors. Surg Neurol 1984; 21: 597–609. 6. Chien YH, Tsao PN, Lee WT, Peng SF, Yau KI. Congenital intracranial teratoma. Pediatr Neurol 2000; 22: 72–74. 7. Levin ML, Leone CR, Kincaid MC. Congenital orbital teratomas. Am J Ophthalmol 1986; 102: 476–481. 8. Mamalis N, Garland PE, Argyle JC, Apple DJ. Congenital orbital teratoma: a review and report of two cases. Surv Ophthalmol 1985; 30: 41–46. 9. Lipman SP, Pretorius DH, Rumack CM, Manco-Johnson ML. Radiology 1985; 157: 491–494. 10. Rostad S, Kleinschmidt-DeMasters BL, Marchester DL. Two massive intracranial immature teratomas with neck extension. Teratology 1985; 32: 163–169.

Thrombospondin-1 serum levels do not correlate with pelvic pain in patients with ovarian endometriosis.

ObjetiveThrombospondin-1 serum levels is correlate with pelvic pain in patients with ovarian endometriosis.PatientsThrombospondin-1 serum levels were prospectively analysed in 51 patients (group A asymptomatic patients or patients presenting mild dysmenorrhea and women comprised group B severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia) who underwent surgery for cystic ovarian endometriosis to asses whether a correlation exists among thrombospondin-1 serum levels and pelvic pain.ResultsFrom 56 patients, five cases were ultimateley excluded, because the histological diagnosis was other than cystic ovarian endometriosis (2 teratomas and 3 haemorragic cysts). The mean thrombospondin-1 serum levels in group A was 256,69 pg/ml_+37,07 and in group B was 291,41 pg/ml + 35,59.ConclusionPain symptoms in ovarian endometriosis is not correlated with thrombospondin-1 serum levels.