The aim of this prospective study lasting 4 years was to develop a scoring system using clinical parameters, sonographic findings, and transvaginal color and pulsed Doppler impedance values for the preoperative recognition of cystic teratoma. A total of 887 benign and malignant adnexal masses, among which 102 were histologically proved to be cystic teratomas, were evaluated. Using morphological criteria, cystic teratoma was successfully predicted in 95 patients. The sensitivity and specificity of a morphological scoring system were 93.1% and 99.4%, respectively, while positive and negative predictive values were 95.0% and 99.1%. A scoring system using both morphology and vascular assessment demonstrated higher sensitivity and specificity (99.02%, 99.75%). The application of a scoring system combining morphology and vascularity improves the accuracy of diagnosing cystic teratoma and of separating this entity preoperatively from other benign and malignant ovarian conditions.

Adnexa Uteri↗

PubMedDate not supplied

Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns.

A case control study of 59 women with subchorionic hematomas compared to 135 normally pregnant. Transvaginal ultrasound was used to image the pregnancy, and identify the site and size of the hematomas. Color flow Doppler was used to calculate velocity indices of the spiral arteries. More spontaneous abortions occurred in women with subchorionic hematomas (SCH). There was general correlation between gestational age, velocity indices, and hematoma size. There were 10 spontaneous abortions in the study group (17%) versus 9 (6.5%) in the controls (P = 0.02). Hematoma size did not affect outcome, but site did. Most hematomas associated with abortion were found in the corpus or fundus of the uterus, not in the supracervical area (P = 0.03). The presence of a hematoma did not affect the frequency of preterm delivery. In conclusion, subchorionic hematomas in early pregnancy are associated with an increased risk of spontaneous abortion. Flow disturbances are seen in the spiral arteries, but these are probably secondary effects. The critical factor is site of hematoma, not volume.

Abortion, Spontaneous↗

PubMedDate not supplied

Intra-uterine insemination with prepared sperm vs. unprepared first split ejaculates. A randomized study.

In this randomized prospective study, we determined the conception rate following intra-uterine insemination with washed and prepared sperm, or with the first portion of a split ejaculate, in couples with longstanding male (n = 27, 70 treatment cycles) or cervical infertility (n = 14, 29 treatment cycles). Folliculogenesis and ovulation were induced by human menopausal gonadotropin and human chorionic gonadotropin. Significantly more couples conceived in the male infertility group following intra-uterine insemination with washed sperm, than after intra-uterine insemination with split ejaculate (9 vs. 2; P less than 0.05), while no difference in pregnancy rate (2 vs. 2) was found by the two intra-uterine insemination methods in the cervical infertility group.

Cell Separation↗

PubMedDate not supplied

Transvaginal ultrasound and diagnostic hysteroscopy as a predictor of endometrial polyps: risk factors for premalignancy and malignancy.

The aim of this study is to assess accuracy of transvaginal ultrasound (TVUS) and diagnostic hysteroscopy in diagnosing endometrial polyps and to determine premalignancy and malignancy rates in asymptomatic women. The study was designed to retrospectively analyze 438 women who underwent operative hysteroscopy in a day-care unit when endometrial polyp was suspected after TVUS and diagnostic hysteroscopy. Multivariate logistic regression modeling showed effects of age, previous breast cancer with tamoxifen treatment, and menopause with or without bleeding on pathologic results. The results indicate that positive predictive value of TVUS with diagnostic hysteroscopy was 79.9%. Premalignancy or malignancy occurred in 3.2% and was significantly related to menopause with abnormal bleeding (P < 0.001), which carried a 20-fold higher risk of pathology than any other group. Age was also a risk factor. It was concluded that TVUS with diagnostic hysteroscopy reliably evaluates endometrial polyps. The low incidence of endometrial tumors in asymptomatic (especially premenopausal) women suggests that their operative evaluation may not be cost effective. Larger studies are needed to support this tentative conclusion.

Adult↗

PubMedDate not supplied

Computed tomographic evaluation of cervical carotid plaque complications.

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Arteriosclerosis↗

PubMedDate not supplied

Post-stroke depression: relationships to functional impairment, coping strategies, and rehabilitation outcome.

This study examined the phenomenon of post-stroke depression and evaluated its impact on rehabilitation outcome. Sixty-four patients presenting to a rehabilitation program within weeks of first stroke were evaluated for depression through self-report measures and staff ratings. Patients also rated the particular coping strategies which they used in dealing with their illness and hospital stay. Physical and occupational therapists provided measures of functional impairment at admission and discharge. A high (47%) prevalence of depression was found in this population, with no overall differences observed between patients with right or left hemisphere lesions. Depressed patients, in comparison to non-depressed, evidenced greater functional impairment at both admission and discharge. However, both groups showed similar gains over the course of rehabilitation. Coping strategies employed by depressed patients appeared to reflect a lower level of participation in the rehabilitation process. A subgroup of patients evaluated 6 weeks after discharge revealed that depression was associated with a worsening on one measure of functional status. These findings indicate that depression is a frequent companion of stroke, that it is associated with degree of functional impairment, and that it may exert a negative impact on the rehabilitation process and outcome.

Adaptation, Psychological↗

PubMedDate not supplied

27 months follow-up study of 41 women who underwent laparoscopic supracervical hysterectomy.

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Cervix Uteri↗