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

Wed, 31 Dec 2008 23:00:00 GMT

Title: Two-dimensional power Doppler-three-dimensional ultrasound imaging of a cesarean section dehiscence with utero-peritoneal fistula: a case report Author(s) : Royo, P. (Pedro); Garcia-Manero, M. (Manuel); Olartecoechea, B. (Begoña); Alcazar, J.L. (Juan Luis) Abstract: Introduction: An imaging diagnosis after an iterative cesarean delivery is reviewed demonstrating a fine ultrasound-pathologic correlation. Case presentation: A 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. Conclusion: We can conclude that transvaginal two-dimensional power Doppler and threedimensional ultrasound are highly accurate in detecting cesarean section dehiscence and uterine fistula.

Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with three-dimensional US

Wed, 31 Dec 2008 23:00:00 GMT

Title: Assessing myometrial infiltration by endometrial cancer: uterine virtual navigation with three-dimensional US Author(s) : Alcazar, J.L. (Juan Luis); Galvan, R. (R.); Albela, S. (Sonia); Martinez, S. (Sergio); Pahisa, J. (Jaume); Jurado, M. (M.); Lopez-Garcia, G. (Guillermo) Abstract: To describe and analyze the diagnostic performance of uterine virtual navigation with three-dimensional (3D) ultrasonography (US) for the assessment of the depth of myometrial infiltration by endometrial cancer. MATERIALS AND METHODS: Institutional review board approval was obtained; patients gave oral informed consent. Women with endometrial cancer were evaluated by using 3D US prior to surgical staging. A 3D volume of the whole uterus was obtained and analyzed by using software. Virtual navigation through three orthogonal planes was performed to identify the shortest myometrial tumor-free distance to serosa (TDS) by analyzing the lateral, anterior, posterior, and fundal portions of the myometrium. Myometrial infiltration was also assessed by subjective impression of an examiner. Histologic findings of myometrial infiltration and TDS measured by a pathologist were used as the reference standard. A receiver operating characteristic curve was plotted to identify the best cutoff for TDS for identifying myometrial infiltration of 50% or more. RESULTS: Ninety-six women (mean age, 61.8 years; range, 31-86 years) with endometrial cancer were included in the study. At histologic analysis, myometrial invasion was found to be less than 50% in 69 (72%) cases and 50% or more in 27 (28%) cases. TDS measured with US was positively correlated with histologically measured TDS (r = 0.649; 95% confidence interval: 0.52, 0.76). The best cutoff for US-measured TDS was 9.0 mm (sensitivity, 100%; specificity, 61%; negative predictive value, 100%; positive predictive value, 50%). Subjective impression had a sensitivity of 92.6%, a specificity of 82.3%, a negative predictive value of 96.6%, and a positive predictive value of 67.7%. CONCLUSION: Uterine virtual navigation with 3D US is a reliable method for the assessment of myometrial infiltration in patients with endometrial cancer.

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

Mon, 31 Dec 2007 23:00:00 GMT

Title: Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system. Author(s) : Alcazar, J.L. (Juan Luis); Royo, P. (Pedro); Jurado, M. (M.); Minguez, J.A. (J.A.); Garcia-Manero, M. (Manuel); Laparte, C. (C.); Galvan, R. (R.); Lopez-Garcia, G. (Guillermo) Abstract: OBJECTIVES: To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment. METHODS: Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology. RESULTS: One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant. CONCLUSIONS: Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach.

Three-dimensional power Doppler derived vascular indices: what are we measuring and how are we doing it?

Mon, 31 Dec 2007 23:00:00 GMT

Title: Three-dimensional power Doppler derived vascular indices: what are we measuring and how are we doing it? Author(s) : Alcazar, J.L. (Juan Luis)

Neoangiogenesis in early cervical cancer: Correlation between color Doppler findings and risk factors. A prospective observational study

Mon, 31 Dec 2007 23:00:00 GMT

Title: Neoangiogenesis in early cervical cancer: Correlation between color Doppler findings and risk factors. A prospective observational study Author(s) : Jurado, M. (M.); Galvan, R. (R.); Martinez-Monge, R. (Rafael); Mazaira, J. (Jesús); Alcazar, J.L. (Juan Luis) Abstract: Background: The aim of the present article was to evaluate whether angiogenic parameters as assessed by transvaginal color Doppler ultrasound (TVCD) may predict those prognostic factors related to recurrence. Methods: A total of 27 patients (mean age: 51.3 years, range: 29 to 85) with histologically proven early stage invasive cervical cancer were evaluated by TVCD prior to surgery. Subjective assessment of the amount of vessels within the tumor (scanty-moderate or abundant) and pulsatility index (PI) were recorded. All patients underwent radical hysterectomy and pelvic lymph node dissection. Postoperative treatment (RT or chemoradiotherapy) was given according to risk factors (positive lymph nodes, parametrial and vaginal margin involvement, depth stromal invasion, lymph-vascular space involvement) Results: Tumors with "abundant" vascularization were significantly associated with pelvic lymph node metastases, depth stromal invasion > 10 mm, lymph-vascular space involvement, tumor diameter > 17.5 mm, and parametrial involvement. Postoperative treatment was significantly more frequent in patients with "abundant" vascularization (OR: 20.8, 95% CIs: 2 to 211). The presence of scanty-moderate vascularization with a PI < 0.82 or abundant vascularization with either PI > 0.82 or PI < 0.82 was associated with high-risk group in 94.4% of the cases (OR: 21.2, 95% CI: 1.9 to 236.0) Conclusion: The results are consistent with a relationship between tumor angiogenesis and prognostic factors for recurrence in early cervical cancer. "Abundant" vascularization and PI < 0.82 may be related to postoperative treatment due to risk factors.

Transvaginal color Doppler assessment of venous flow in adnexal masses

Sun, 31 Dec 2000 23:00:00 GMT

Title: Transvaginal color Doppler assessment of venous flow in adnexal masses Author(s) : Alcazar, J.L. (Juan Luis); Lopez-Garcia, G. (Guillermo) Abstract: Objective To analyze the usefulness of transvaginal color Doppler assessment of venous flow in the differential diagnosis of adnexal masses. Material and Methods Ninety-one consecutive patients (mean age: 46.6 years, range: 16–81 years) diagnosed as having an adnexal mass were evaluated by transvaginal color Doppler sonography prior to surgery. Color Doppler was used to detect and analyze the flow velocity waveform from arterial and venous blood flow within the tumor. For arterial signals the resistance index and peak systolic velocity, and for veins the maximum venous flow velocity, were calculated. Receiver operator characteristic curves were plotted to determine the best venous flow velocity cut-off. According to our previous study using arterial Doppler, a tumor was considered as malignant when flow was detected and the lowest resistance index was ≤ 0.45. Using venous Doppler a mass was considered as malignant when flow was detected and the venous flow velocity was ≥ the best cut-off found on the receiver operator characteristic curve. Definitive histopathological diagnosis was obtained in all cases. Sensitivity, specificity, positive predictive value and negative predictive value for B-mode morphology (evaluation performed according to Sassone’s scoring system), arterial Doppler, venous Doppler, and a combination of both arterial and venous Doppler were calculated. Results Twenty-five masses (27.5%) were malignant and 66 (72.5%) benign. Arterial and venous flow was found more frequently in malignant than in benign masses (92% vs. 41% (P < 0.001) and 72% vs. 21% (P < 0.001), respectively). The resistance index was significantly lower in malignant tumors (0.42 vs. 0.60, P = 0.0003). No differences were found in peak systolic velocity. Venous flow velocity was significantly higher in malignant masses (18.1 cm/s vs. 8.9 cm/s, P = 0.0006). The best cut-off of venous flow velocity was 10 cm/s. Sensitivity, specificity, positive predictive value and negative predictive value for morphology, arterial Doppler, venous Doppler, and the combination of both arterial and venous Doppler were 92%, 71%, 45%, 96%; 76%, 95%, 87%, 91%; 68%, 94%, 81%, 89%; and 88%, 91%, 79%, 95%, respectively. Conclusions Our results indicate that preoperative evaluation by venous flow assessment of adnexal masses may be useful to discriminate between malignant and benign tumors.

Postpartum ovarian vein thrombosis after cesarean delivery: a case report

Mon, 31 Dec 2007 23:00:00 GMT

Title: Postpartum ovarian vein thrombosis after cesarean delivery: a case report Author(s) : Royo, P. (Pedro); Alonso-Burgos, A. (Alberto); Garcia-Manero, M. (Manuel); Lecumberri, R. (Ramón); Alcazar, J.L. (Juan Luis) Abstract: Introduction: Postpartum 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 presentation: A 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. Conclusion: Low-molecular weight heparin with broad-spectrum antibiotics are the accepted therapy in non-complicated cases of postpartum ovarian vein thrombosis.

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

Wed, 31 Dec 2008 23:00:00 GMT

Title: Endometriosis in a postmenopausal woman without previous hormonal therapy: a case report Author(s) : Garcia-Manero, M. (Manuel); Royo, P. (Pedro); Olartecoechea, B. (Begoña); Alcazar, J.L. (Juan Luis) Abstract: Introduction The 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 presentation We 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. Conclusion Although 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.

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

Wed, 31 Dec 2008 23:00:00 GMT

Title: Thrombospondin-1 serum levels do not correlate with pelvic pain in patients with ovarian endometriosis Author(s) : Garcia-Manero, M. (Manuel); Olartecoechea, B. (Begoña); Royo, P. (Pedro); Alcazar, J.L. (Juan Luis) Abstract: Objetive: Thrombospondin-1 serum levels is correlate with pelvic pain in patients with ovarian endometriosis. Patients: Thrombospondin-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. Results: From 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. Conclusion: Pain symptoms in ovarian endometriosis is not correlated with thrombospondin-1 serum levels.

Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women

Thu, 31 Dec 2009 23:00:00 GMT

Title: Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women Author(s) : Alcazar, J.L. (Juan Luis); Leon, M. (M.); Galvan, L. (Luis); Guerriero, S. (S.) Abstract: Objective To assess whether the analysis of cyst content using mean gray value (MGV) can discriminate ovarian endometriomas from other unilocular ovarian cysts in premenopausal women. Methods Stored three-dimensional (3D) volumes from 54 unilocular ovarian cysts diagnosed in 50 premenopausal women (mean age, 37 (range, 22–50) years) were analyzed to calculate the MGV from cyst content. Cysts with solid components or septations were excluded. MGV was calculated in all cases with the Virtual Organ Computer-aided AnaLysisTM technique. The Bmode presumptive diagnosis based on the examiner’s subjective impression was also recorded. Results Sixteen of the cysts resolved spontaneously and were given a final clinical diagnosis of hemorrhagic functional cyst, while 38 cysts were removed surgically (diagnosed histologically as seven simple cysts, three hemorrhagic cysts, 20 endometriomas, five mucinous cysts and three paraovarian cysts). B-mode diagnoses were as follows: seven simple cysts, 18 hemorrhagic cysts, 24 endometriomas, three mucinous cysts and two paraovarian cysts. MGV was significantly higher in ovarian endometrioma when compared with all other kinds of cyst. The receiver–operating characteristics curve showed that using an MGV cut-off ≥15.560 had a sensitivity of 85% and a specificity of 76.5% for diagnosing ovarian endometrioma (area under the curve, 0.831; 95% CI, 0.718–0.944). These figures were similar to those for B-mode diagnosis (sensitivity, 90%; specificity, 82%) (McNemar test, P = 1.000). Combining B-mode and MGV gave a sensitivity of 80% and a specificity of 91%. Conclusion Cyst content MGV is higher in ovarian endometrioma than it is in other unilocular ovarian cysts. The diagnostic performance of MGV is similar to that of the examiner’s subjective impression. The combination of both criteria achieves the highest specificity

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

Wed, 31 Dec 2008 23:00:00 GMT

Title: The value of minilaparotomy for total hysterectomy for benign uterine disease: A comparative study with conventional Pfannenstiel and laparoscopic approaches Author(s) : Royo, P. (Pedro); Alcazar, J.L. (Juan Luis); Garcia-Manero, M. (Manuel); Olartecoechea, B. (Begoña); Lopez-Garcia, G. (Guillermo) Abstract: 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.

Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics

Thu, 31 Dec 2009 23:00:00 GMT

Title: Three-dimensional power Doppler angiography in endometrial cancer: correlation with tumor characteristics Author(s) : Galvan, R. (R.); Merce, L. (L.); Jurado, M. (M.); Minguez, J.A. (J.A.); Lopez-Garcia, G. (Guillermo); Alcazar, J.L. (Juan Luis) Abstract: To assess the correlation between intratumoral vascularization using three-dimensional power Doppler angiography (3D-PDA) and several histological tumor characteristics in a series of patients with endometrial carcinoma. METHODS: Ninety-nine women (mean age, 61.7 (range, 31-84) years) diagnosed as having endometrial cancer were assessed by transvaginal 3D-PDA before surgical staging. Endometrial volume (EV) and 3D-PDA vascular indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) were calculated using the Virtual Organ Computer-aided AnaLysis (VOCAL) method. All patients were surgically staged. Individual tumor features such as histological type, tumor grade, myometrial infiltration depth, lymph-vascular space involvement, cervical involvement, lymph node metastases and tumor stage were considered for analysis. Multivariate logistic regression (MLR) analysis was used to determine which 3D-PDA parameters were independently associated with each histological characteristic. RESULTS: MLR analysis showed that only EV and VI were independently associated with myometrial infiltration (EV: odds ratio (OR), 1.119 (95% CI, 1.025-1.221), P = 0.012; VI: OR, 1.127 (95% CI, 1.063-1.195), P = 0.001) and tumor stage (EV: OR, 1.103 (95% CI, 1.012-1.202), P = 0.025; VI: OR, 1.120 (95% CI, 1.057-1.187), P = 0.001), only VI was independently associated with tumor grade (OR, 1.056 (95% CI, 1.023-1.091), P = 0.001) and only EV was independently associated with lymph node metastases (OR, 1.086 (95% CI, 1.017-1.161), P = 0.001). CONCLUSION: 3D-PDA analysis of tumor vascularization in endometrial cancer correlates with some prognostic histological characteristics.

El aborto. Análisis crítico de la situación actual

Tue, 31 Dec 1974 23:00:00 GMT

Title: El aborto. Análisis crítico de la situación actual Author(s) : Lopez-Garcia, G. (Guillermo) Abstract: The author begins this work by making an exposition of those facts which we could call fundamental from the biological point of view to understand and judge the different birth control methods in use today. From the very moment of the fertilization of the ovum by the spermatozoid. the development plans of a new organism become imprinted. This new organism is endowed with an extraordinary functional capacity whose determination is unaffected by the relations between the maternal organism and the fetal organismo These facts are so apparent that. Jf the beginning of Iife is not located in fecundation . there exist no concrete re· ferences as to when it does in fact take place. Abortive birth control methods are those which interrupt embryonic -or fetal- development. no matter the mechanism of action employed nor the time elapsed since the fertilization of the ovum. The spreading of these abortive methods has been noteworthy. with the proliferation of contraceptive methods -mainly the hormonal ones (the «pill .. )which have served as the key which has opened the door for abortion. Jt can be demonstrated how in these last fifteen years the relation between contraceptives and abortion is indeed intimate, and it beco mes difficult to separate them in practice. The laws promulgated in a large number of countries in recent years approving abortion have created in the public at large a conceptual confusion which makes that «Iegalized», .inducedD, «provoked», «criminal» ... abortions become differentiated only with sorne difficulty, whereas in point of fact the differences are quite c1ear. The only abortion which can be conside'red legal is spontaneous abortion (miscarriage) which occurs independently of the will of the mother and that of the doctor; all other cases deal with provoked abortion and signify the direct death of an individual. Jt is no doubt true that juridical legality do es not necessarily identify itself with ethical norms and that it cannot be the fundament of doctrinal norms of conduct; it is precisely from this that even «Iegalized» abortion continues to be a crime. Finally, the author makes reference to the relations between abortion and euthanasia which are increasing evident as time goes by. It is foreseeable that in the next few years the first laws allowing euthanasia will be approved, signifying yet a further step in the escalation of the anti-life movement.