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The article presents research which examined the efficiency of the use of hysteroscopy in treating pathology within endocervix and uterine cavity of pregnant patients. This technology enables medical professionals to visualize the endometrial cavity, endocervical canal as well as fallopian tube ostia. The study found that hysteroscopic procedure should be discussed between the patient and physician during a preoperative consultation.

Objective. To evaluate accuracy of transvaginal sonography (TVS) and hysteroscopy in detection of intrauterine pathology in infertile women. Subjects and methods. This retrospective study was conducted in 56 infertile women with abnormal transvaginal ultrasound findings of the uterine cavity which was performed during the midfollicular phase as a part of routine infertility workup. Hysteroscopy was performed between 6th and 10th day of cycle. Results. The mean age of the subjects was 31.9±4.0. The most frequent ultrasound finding was endometrial polyp in 34 (60.7%) patients, septate uterus in 8 (14.3%) patients, submucosal myoma in 7 (12.5%) patients, endometrial hyperplasia in 5 (8.9%) patients and Syndroma Ascherman in 2 (3.6%) patients. Hysteroscopy confirmed 20 (35.7%) polyps, the same number of myomas, septate uterus and Syndroma Ascherman as detected by ultrasound, (7 (12.5%), 8 (14.3%) and 2 (3.6%), respectively) and 19 (33.9%) endometrial hyperplasia. In 46 women with histological excamination, the sensitivity of TVS and hysteroscopy in the diagnosis of endometrial polyps were identical - 100%, while the specificity was higher in hysteroscopy than in TVS (92.3% versus 56.4%, p<0.001). The sensitivity of TVS in the diagnosis of endometrial hyperplasia was higher than that of hysteroscopy (86.4% versus 22.7%, p<0.001), while specificity was identical, of 100%. Accordance between hysteroscopy and histology was good (κ=0.79), between ultrasound and hystology was moderete (κ=0.59). Conclusion. Hysteroscopy appeared to be more reliable in diagnosis than TVS. The use of a high frequency ultrasound probe leads us to a lack of diagnostic clarity between endometrial polyps and hyperplasia. [ABSTRACT FROM AUTHOR]

The article analyzes the importance of office hysteroscopy screening in the diagnosis of endometrial carcinoma in menopausal women. It explains that office hysteroscopy is carried out as a useful exam in achieving diagnosis of atypical uterine bleeding through transvaginal sonography (TVS). The authors also conclude that hysteroscopy is an essential tool in the diagnosis of endometrial cancer since it enables a complete overview of the uterine cavity and it is highly tolerated by patients.

Objective: To correlate lower uterine segment (LUS) thickness measured by abdominal sonography at term pregnancy with that measured manually using caliper at cesarean delivery and to find out minimum LUS thickness indicative of its integrity in women with previous cesarean. Methods: In 106 women with previous cesarean delivery and 68 with unscarred uterus, abdominal sonographic assessment of LUS was carried out within a week of delivery. Sonographic measurements were correlated with manual measurement of lower flap of LUS using Vernier calipers in 96 of these women (64 with previous cesarean and 32 of unscarred uterus) who had elective cesarean delivery. Results: Sonographically determined LUS was thinner among women with previous cesarean delivery than in those without (4.58 SD 1.05 vs. 4.8 SD 0.8; t = 1.986; p = 0.04). Women with vaginal birth after cesarean had thicker LUS than women with repeat cesarean delivery (4.4 SD 0.97 vs. 4.48 SD 1.0). The findings were not influenced by engaged fetal head status or amount of bladder fullness. Directly measured LUS thickness using Vernier calipers before delivery of the baby confirmed ultrasound measurements, but showed smaller differences between them. There were eight cases with defective uterine scar at cesarean. LUS thickness at term of 3 mm provided 87.5% sensitivity and specificity, and was found to have negative predictive value of 98%. But in two of seven cases the actual LUS was not measurable despite sonographic measurement of 3 mm, and there were two records of scar dehiscence in those with 3 and 4 mm of LUS thickness. Conclusion: LUS thickness of 3 mm measured by abdominal ultrasonography prior to delivery at term in women with previous cesarean is suggestive of stronger LUS but is not a reliable safeguard for trial of labor. [ABSTRACT FROM AUTHOR]

Objective: To report a retrospective series of proximal ureteral stone ureteroscopies (URS) by a single surgeon, using results presented in a recommended format from the American Urological Association Ureteral Stone Guideline panel, with an emphasis on outcomes related to obesity. Methods: A retrospective chart review of a single surgeon''s 2-year URS experience was performed. Of the 55 ureteroscopies for proximal ureteral calculi, 49 cases involving 43 patients had evaluable postoperative imaging. Results: Mean patient age was 56 years and average body mass index was 32.5 kg/m2. Average ureteral stone size was 9.1 mm; 51% had been preoperatively stented and 93% were stented postoperatively. The overall ureteral stone–free rate was 86%. Overall, 5/43 patients (11%), none of whom were obese, required a second procedure. Obese patients had a 91% stone-free rate, statistically equivalent to the 81% rate in the nonobese. Three patients (7%) developed postoperative urinary tract infections. One patient came to the emergency department for stent-related discomfort. One patient treated in a staged setting for bilateral ureteral calculi developed urinary tract infection and systemic inflammatory response system complicated by alcohol withdrawal requiring a 3-day non–intensive care unit admission. Conclusions: Proximal ureteral calculi can be successfully treated with URS most of the time, but the risk for persistent renal calculi and fragments exists. The complication rate is low and operative times are short. Obese patients can also be successfully treated ureteroscopically. [Copyright &y& Elsevier]

Objectives. To study (1) the prevalence of different types of gestational trophoblastic neoplasia (GTN) in the local and nonlocal population of women at Al Wasl Hospital, a tertiary level referral centre for northern Emirates, (2) the safety of cervical preparation before uterine evacuation, (3) the role of repeat uterine evacuation in curing these cases, and (4) the percentage of cases ultimately requiring chemotherapy. Material and Methods. Retrospective analysis of case records of 35 women with diagnosis of gestational trophoblastic neoplasia were managed in the Department of Obstetrics and Gynecology at Al Wasl Hospital, over a 2-year period between January 2007 to December 2008. Results. 35 cases of gestational trophoblastic neoplasia were seen in a 2-year period (January 2007 to December 2008) at Al Wasl Hospital, with 7000 deliveries per year, prevalence being 1 in 400 live births. 60% cases were local Arabs. Histopathology revealed complete mole in 13 cases, partial mole in 17 cases, hydropic degeneration of villi in 4 cases, and no identifiable tissue in 1 case. No cases of choriocarcinoma or placental site trophoblastic tumour were seen during the study period. 34% cases received cervical preparation with prostaglandins prior to surgical curettage. Complications were minor. 62% were cured by primary suction curettage, 12% after second (repeat) uterine evacuation, and 25% needed single drug chemotherapy. 8% cases defaulted after primary evacuation and were lost to followup. Conclusions. Prevalence of GTN in the local Arab population is similar to other Asian populations. The majority of cases are cured by simple suction uterine curettage. Cervical preparation with prostaglandins should be done in selected cases to avoid perforation during evacuation. Second (repeat) uterine evacuation can be curative in some cases with strict selection criteria and avoid the need for chemotherapy. Regional registry of cases is needed to estimate the true incidence of this disease. [ABSTRACT FROM AUTHOR]

Subtotal hysterectomy (SH), which is also referred to as supracervical hysterectomy, is a common gynaecological procedure in which the uterus is removed and the cervix is retained. There is continuing debate about the advantages and disadvantages of SH compared with total abdominal hysterectomy. Persistent vaginal bleeding and the need for continued cervical screening appear to be the main disadvantages of SH. The procedure is often combined with removal of the ovaries. Women should be counselled appropriately prior to removal of their ovaries. Following an internal audit of practice of hormone replacement therapy (HRT) prescription within our own unit, we discovered that there were inconsistencies in the prescription of HRT following SH which led us to investigate this matter further. We concluded that evidence is lacking to guide HRT prescription following SH and bilateral oophorectomy and propose content that can help produce guidelines for the counselling of women prior to SH and prescription of HRT. [ABSTRACT FROM AUTHOR]

Dioxins have been reported to exert various adverse effects, including cell-cycle dysregulation in vitro and impairment of spatial learning and memory after in utero exposure in rodents. Furthermore, children born to mothers who are exposed to dioxin analogs polychlorinated dibenzofurans or polychlorinated biphenyls have developmental impairments in cognitive functions. Here, we show that in utero exposure to dioxins in mice alters differentiation patterns of neural progenitors and leads to decreased numbers of non-GABAergic neurons and thinner deep neocortical layers. This reduction in number of non-GABAergic neurons is assumed to be caused by accumulation of cyclin-dependent kinase inhibitor p27Kip1 in nuclei of neural progenitors. Lending support to this presumption, mice lacking p27Kip1 are not susceptible to in utero dioxin exposure. These results show that environmental pollutants may affect neocortical histogenesis through alterations of functions of specific gene(s)/protein(s) (in our case, dioxins), exerting adverse effects by altering functions of p27Kip1. [ABSTRACT FROM AUTHOR]

Dioxins have been reported to exert various adverse effects, including cell-cycle dysregulation in vitro and impairment of spatial learning and memory after in utero exposure in rodents. Furthermore, children born to mothers who are exposed to dioxin analogs polychlorinated dibenzofurans or polychlorinated biphenyls have developmental impairments in cognitive functions. Here, we show that in utero exposure to dioxins in mice alters differentiation patterns of neural progenitors and leads to decreased numbers of non-GABAergic neurons and thinner deep neocortical layers. This reduction in number of non-GABAergic neurons is assumed to be caused by accumulation of cyclin-dependent kinase inhibitor p27Kip1 in nuclei of neural progenitors. Lending support to this presumption, mice lacking p27Kip1 are not susceptible to in utero dioxin exposure. These results show that environmental pollutants may affect neocortical histogenesis through alterations of functions of specific gene(s)/protein(s) (in our case, dioxins), exerting adverse effects by altering functions of p27Kip1. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a novel educational curriculum using a simulation teaching laboratory improves resident knowledge, comfort with, and surgical performance of hysteroscopic sterilization.Design: An educational prospective, pretest/posttest study.Setting: The Montefiore Institute of Minimally Invasive Surgery Laboratory. PATIENT(S)/SUBJECT(S): Thirty-four OB/GYN residents in an academic medical center.Intervention(s): Hysteroscopic sterilization simulation laboratory and a brief didactic lecture.Main Outcome Measure(s): Differences in scores on validated skill assessment tools: Task specific checklist, Global Rating Scale (GRS), pass fail assessment, and a multiple-choice examination to evaluate knowledge and attitude.Result(s): In the entire cohort improvements were observed on all evaluation tools after the simulation laboratory, with 31% points (SD+/-11.5, 95% confidence interval [CI] 27.3-35.3) higher score on the written evaluation; 63% points (SD+/-15.7, 95% CI 57.8-68.8) higher score on the task specific checklist; and 54% points (SD+/-13.6, 95% CI 48.8-58.3) higher score on the GRS. Higher PGY status was correlated with better pretest performance, but was not statistically significant in posttest scores. Residents reported an improvement in comfort performing the procedure after the laboratory.Conclusion(s): Simulation laboratory teaching significantly improved resident knowledge, comfort level, and technical skill performance of hysteroscopic sterilization. [ABSTRACT FROM AUTHOR]

This study investigated the apparent diffusion coefficients (ADCs) of the uterine zonal structures (myometrium, endometrium and junctional zone) among reproductive women, and their changes during the menstrual cycle. Magnetic resonance (MR) images of seven healthy females (aged 24-31 years) were obtained during the periovulatory, luteal and menstrual phases. Diffusion-weighted imaging (DWI) was performed with a single-shot echo-planar imaging (EPI) sequence in the midsagittal plane of the uterus using three b-values (b=0, 500 or 1000 smm-2). The ADC values of the three uterine zonal structureswere measured on an ADC map by placing two regions of interest (ROI) on the corresponding zonal structures. The average changes of ADC values (intraindividual ADC value variation) over three menstrual phases were 0.41×10-3 mm2 s-1 (range, 0.08-0.91) for myometrium, 0.55×10-3 mm2 s-1 (0.35-0.84) for endometrium, and 0.40×10-3 mm2 s-1 (0.18-0.59) for the junctional zone. The ADC values for myometrium and endometrium were lower in the menstrual phase, although there was some overlap of individual values. Interindividual variation in ADC value for a given zone or phase ranged from 0.48×10-3 mm2 s-1 to 0.85×10-3 mm2 s-1. Intermeasurement variation between the two ROIs ranged from 0 to 0.48×10-3 mm2 s-1 per measurement. The magnitude of these variations was comparable to reported differences between malignant and non-malignant tissues. These preliminary results, from a small number of subjects, suggest that the menstrual cycle and individual variation in pre-menopausal women should be considered when interpreting the ADC values of uterine structures. [ABSTRACT FROM AUTHOR]

The aim of the study is to assess the diagnostic accuracy, findings and feasibility of office-based diagnostic hysteroscopy in an IVF population. A total of 2500 consecutive infertile patients were enrolled prospectively prior to IVF treatment. Diagnostic hysteroscopy was performed on each subject in an office setting in the study IVF centre. A total of 1927 patients (77.1%) had a normal uterine cavity, while the remainder of the sample (n = 573) demonstrated endometrial pathology on hysteroscopy (22.9%). Of the patients with endometrial pathology, 192 patients had endometrial polyps (7.68%), 96 patients had submucosal fibroids (3.84%), 31 patients had polypoid endometria (1.24%), 27 patients had intrauterine adhesions (1.08%) and 73 patients had uterine septa (2.92%). Diagnostic office-based hysteroscopy is routinely performed in the IVF clinic to assess the endometrial cavity. In such an unselected population, a significant percentage of patients had evidence of uterine pathology that may have impaired the success of IVF. Safety, ease of use, high diagnostic accuracy and high patient tolerance makes office-based hysteroscopy an ideal procedure. [ABSTRACT FROM AUTHOR]

Objective: In this study we tried to find relationship between location, size and clinical symptoms of uterine polyps. Methodology: Our cross sectional study was performed during the year 2008 in Ahwaz Imam Khomayni Hospital. Patients who underwent office hysteroscopy were evaluated and those with hysteroscopic diagnosis of polyp were entered in the study. Hysteroscopic findings of location and size of polyps and clinical presentations of Abnormal Uterine Bleeding (AUB) dysmenorrhea, infertility, discharge, spotting plus discharge were evaluated. Results: One hundred and twenty four patients were evaluated. The most common location of polyp and clinical presentation were cervical canal and AUB, respectively. Polyp sizes of equall or less than 1 cm are commonly seen in cervical canal and cornea and more than 1 cm polyps are commonly found in uterine cavity and near internal os. Conclusion: In this study we showed that location of polyp is important in clinical presentation. Patients presented with AUB had polyps more common in uterine cavity, patients with spotting plus discharge had polyps more in cervical canal. [ABSTRACT FROM AUTHOR]

The article presents a study which explores the alternative methods for the diagnosis of abnormal labor progression and investigates the labor patterns in women. The study uses the data from the National Collaborative Perinatal Project wherein 26,838 women admitted at different levels of cervical dilation were observed and the cumulated labor duration was calculated. The results show that nulliparous women have slower cervical dilation than in multiparous women.

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To study the effect of raloxifene on endometrial histopathology of menopausal women. Methods: Thirty-one patients under raloxifene treatment (60 mg/day) for a six-month period and submitted to diagnostic videohysteroscopy at the Climateric Outpatients Clinic, Department of Gynecology and Obstetrics, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, in the city of São Paulo, and at Hospital Guilherme Álvaro, in the city of Santos, from September 10th, 2003 to June 22nd, 2004, were analyzed. Guided endometrial biopsy was performed on all patients on the anterior wall, using a 3-mm or 5-mm biopsy forceps. A 3-mm or 5-mm hysteroscope was used with TV imaging by an endocamera. The results of the hysteroscopic tests were compared before and six months after the use of raloxifene. Results: The comparison between both biopsies was performed by means of the McNemar's test (marginal homogeneity test), and showed a descriptive level of 0.001 that indicates difference between the estrogen effects assessed at different moments. The estrogen effect on the endometrial tissue did not increase in any of the 31 patients analyzed. Twenty-one patients (68%) showed smaller estrogen effect in the final evaluation. Conclusions: The study showed no evidence of endometrial stimulation of raloxifene and, in fact, many women presented less estrogen effect after its use. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although hysteroscopy is frequently used in the management of subfertile women, a systematic review of the evidence on this subject is lacking. [ABSTRACT FROM PUBLISHER]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The extraction of the frequency components of a signal can be useful for the characterization of the underlying system. One method for isolating a frequency component of a signal is by the extraction and reconstruction of the local maxima or ridge of its time-frequency representation. We compare here the performances of two well-known ridge reconstruction methods, namely the Carmona and Marseille methods, on synthetic signals as well as real electrohysterogram (EHG). We show that Carmona's method presents lower reconstruction errors. We then used the separately reconstructed frequency components of the EHG independently for labor prediction using a synchronization measure. We show that the proposed synchronization parameters present similar prediction rate to classical parameters obtained directly from the time-frequency representation but also seem to provide information complementary to the classical parameters and may thus improve the accuracy in labor prediction when they are used jointly. [ABSTRACT FROM AUTHOR]

Aim: We investigated the transcervical hysteroscopy application of n-butyl-2-cyanoacrylate in the uterine tube lumen of a non-rodent animals (sheep) with fallopian tube dimensions similar those in humans. Methods: Standard hysteroscopic procedures were performed on female Texel sheep ( n = 26). The right and left ostia were identified. For each ewe, a urethral catheter (5Fr) was used for the delivery of 0.5 mL of saline or an equal volume of n-butyl-2-cyanoacrylate into the uterine tube. Following the procedure, ewes were housed with males of proven fertility for 90 days (equivalent to 5.5 estrous cycles). Postmortem (dye and burst pressure) and in vivo (hysterosalpingogram) testing for tube patency were both performed 90 days and 180 days following the procedure. Results: All animals receiving the saline treatment became pregnant. Gross inspection of uterine tubes following n-butyl-2-cyanoacrylate treatment revealed no visceral adhesions or fibrosis. However, postmortem testing revealed total obstruction within the fallopian tubes. This was confirmed by hysterosalpingogram, in that iodine contrast did not escape into the abdominal cavity. Conclusion: The cyanoacrylate promoted a reliable fallopian tube obstruction without fibrosis in an animal model exhibiting a similar tube diameter to that found in women. The technique can be evaluated for efficacy in vivo using hysterosalpingography. [ABSTRACT FROM AUTHOR]

Abstract: Background: To evaluate the diagnostic potential of saline infusion sonography to pick up uterine cavity lesions and compare it with the gold standard office hysteroscopy. Methods: Study population consisted of women scheduled for office hysteroscopy for various indications. Uterine cavity of 208 women of the study group were evaluated first by saline infusion sonography and then by office hysteroscopy by two separate examiners. Findings were recorded separately for both procedures and compared. Pain rating was also noted after each procedure. Result: In eight patients either or both the procedures could not be performed for various reasons, hence were excluded from the analysis. With saline infusion sonography, pathological findings were identified in 93 (46.5%) patients and hysteroscopy detected lesions in 88 (44%) patients. For all findings combined sensitivity of saline infusion sonography was 90.9%, specificity 88.3%, positive predictive value 86.0% and negative predictive value 92.5% as compared to hysteroscopy. Former was less painful and easier to perform than the latter. Conclusion: The findings of saline infusion sonography and office hysteroscopy did not differ significantly. Thus saline infusion sonography is an excellent option for uterine cavity evaluation. [Copyright &y& Elsevier]

The article presents a study on the diagnostic accuracy of minihysteroscopy in the identification of intrauterine pathologies. The study highlights to determine the reliability of minihysterscopy in association with fluid distention and vaginoscopic approach for the determination of endometrial pathogenesis. Details of the study are included, showing the technical success of hysteroscopy in all women with reliability of 98%-99% to diagnose endometrial carcinoma. Furthermore, the study concludes on the ease, reliability, acceptability and safety of diagnostic mini-hysteroscopy to patients with an indication of intrauterine exploration.

To investigate the relation between intrauterine pressures and volumes for virtual-reality-based surgical training in hysteroscopy. Ten fresh extirpated uteri were insufflated by commercial hysteroscopy pump and imaged by computer tomography (CT) under intrauterine air pressure in distension–collapse cycles between 0 , 20 (150 mmHg), and 0 kPa, performing a CT scan at every step at about 2.7 kPa (20 mmHg). An initial threshold pressure to distend the cavity was avoided by introducing the insufflation tube up to the fundus. The filling and release phases of seven uteri that were completely distended showed the typical characteristics of a hysteresis curve which is expected from a viscoelastic, nonlinear, anisotropic soft tissue organ like the uterus. In three cases tightening the extirpated uterus especially at the lateral resection lines caused significant problems that inhibited registration of a complete distension–collapse cycle. Interpolated volumes for complete distended cavities and extrapolated for incomplete data sets, derived from the digitally reconstructed three-dimensional (3D) geometries, ranged from 0.6 to 11.4 mL at 20 kPa. These values highly correlate with the uterine volume (not insufflated) considering different biometric data of the uteri and patient data. Linear ( R2 = 0.66) and quadratic least-squares fits ( R2 = 0.74) were used to derive the formulas y = 0.069 x and y = 0.00037 x2 + 0.036 x, where x is the uterine volume in mL (not insufflated) and y is the cavity volume in mL at 20 kPa intrauterine pressure. Our experimental hysteroscopical setup enabled us to reconstruct the changes in volumes of insufflated uteri under highly realistic conditions in 3D. The relation between intrauterine pressure and cavity volume in distension–collapse cycles describes a typical hysteresis curve. [ABSTRACT FROM AUTHOR]

To determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions. Sixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13th Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree–disagree statements concerning the HystSim training in general. Twenty-six participants had performed more than 50 hysteroscopies (“experts”) and 36 equal to or fewer than 50 (“novices”). Four of 60 (6.6%) responding participants judged the overall impression as “7 – absolutely realistic”, 40 (66.6%) as “6 – realistic”, and 16 (26.6%) as “5 – somewhat realistic”. Novices (6.48; 95% confidence interval [CI] 6.28–6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85–6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients. Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculum. [ABSTRACT FROM AUTHOR]

Objective: To test the ability of a novel phase-shifting medium (PSM) to provide sustained distension of the uterine cavity and produce saline infusion sonography (SIS)-like images in a simplified contrast ultrasound procedure. Design: Prospective pilot feasibility trial of a new diagnostic procedure, contrast ultrasound. Setting: Clinical reproductive endocrine and infertility unit of regional teaching hospital. Patient(s): Twenty-six asymptomatic infertile women (group I) and 27 women presenting with dysfunctional uterine bleeding (DUB) who were scheduled for exploratory surgery (group II). Intervention(s): All women who were temporarily on oral contraceptive first had a regular pelvic ultrasound followed by the intrauterine instillation of up to 3 mL PSM, using a regular insemination catheter, after which all instruments were removed and a regular ultrasound was performed again. Result(s): In all 53 women, intrauterine instillation of 1-3 mL PSM resulted in a 3-7 mm uterine distension, sufficient to produce SIS-like images of the uterine cavity that lasted 7-10 min. Contrast ultrasound revealed an endometrial polyp in 3 asymptomatic women of group I. In group II. 12 of 14 women (86%) whose vaginal ultrasound were positive or dubious had positive findings with contrast ultrasound; 9 of 12 patients whose vaginal ultrasounds were negative also had positive contrast ultrasound findings. All the positive and negative findings of contrast ultrasound made in group II were confirmed anatomically (sensitivity and specificity of 100%), whereas the correlation for standard vaginal ultrasound was markedly lower at 57.1% and 85.7%, respectively. Most patients (46 of 53) reported no discomfort during or after the procedure, and 7 women described the procedure as mildly uncomfortable. Conclusion(s): Contrast ultrasound, a novel simple diagnostic procedure conducted after intrauterine instillation of 1-3 mL PSM using a simple plastic catheter, delivered SIS-quality images in asymptomatic (group I) and symptomatic (group II) patients while retaining the simplicity of standard ultrasound. We therefore foresee broad application of contrast ultrasound for sensitive and specific assessment for uterine pathologies in the physician's office. [ABSTRACT FROM AUTHOR]

• Objective: The objective of this study is to analyze the sensitivity, specificity, positive and negative diagnostic value of transvaginal ultrasonography (TVUSG), dilatation arid curettage (D&C) and hysteroscopy alone or combined which are used in diagnosis of abnormal uterine bleeding and endometrium carcinoma. • Material and Method: Our study includes 113 women, ages varying between 21 and 71, who were admitted to Taksim Training and Research Hospital, Obstetrics and Gynecology Policlinic, suffering from abnormal uterine bleeding (AUB) TVUSG, hysteroscopy and D&C were applied to patients and obtained materials for pathological examination. Then histological findings are compared with ultrasonography and hysteroscopical findings. • Results: There are 3 endometrial cancer patients (2.65%) in 113 AUB cases. 2 of endometrial cancer patients are diagnosed with TVUSG, 1 case could not diagnosed with TVUSG. But with hysteroscopy and D&C, all 3 cases have been diagnosed. When all methods are taken into consideration, in patients complaining from AUB, polyps are leading cause with 30.08 %. Polyps are followed by myoma uteri with 18.58%, endometrial hyperplasia 16.81%, endometrium carcinoma 2.65%. In a group of patients (7.96%.), polyp and myoma are found together. Any organic disease is not established in 23.89% of patients complaining from AUB. • Conclusion: It has been found that the diagnostic value of hysteroscopy is higher than TVUSG. The specificity of D&C for uterine lesions and the positive diagnostic value is higher than TVUSG and hysteroscopy. During the diagnosis of endometrial carcinoma, TVUSG has lower sensitivity and specificity than hysteroscopy and D&C. D&C and hysteroscopy has sensitivity and specificity of 100%. [ABSTRACT FROM AUTHOR]

Aim: To assess the safety of minimally invasive and hysteroscopic diagnosis and treatment of abnormal uterine bleeding and intrauterine abnormalities in patients after organ transplantation. Methods: After kidney, pancreas, or liver transplantation, patients who presented with menorrhagia, submucosal myoma or thickened endometrium on ultrasound were diagnosed and treated using a hysteroscopic system Versascope, Bipolar Resectoscopic System and intrauterine system ThermaChoice. Results: Twenty patients were included in this study and were aged 37–63 years (average ± standard deviation: 48.8 ± 5.86). The follow up was between 3 and 122 months (44.8 ± 31.91). All hysteroscopic procedures were performed under general anesthesia, using local anesthetics (paracervical block) or short-term i.v. anesthesia, plus antibiotics. The procedures lasted 5 to 15 min (9.4 ± 2.44). Five patients presented with minimal blood loss (≤100 mL) and the rest had no blood loss. The hysteroscopic procedures had no adverse effects on the function of transplanted organs and there were no associated postoperative complications. Uterine bleeding was successfully regulated in all patients. Conclusion: Minimally invasive procedures and hysteroscopy of organ-transplanted patients provide a safe solution for the treatment of menorrhagia, submucosal myoma and thick endometrium in postmenopausal patients. [ABSTRACT FROM AUTHOR]

Objective: To illustrate the large variety of pathologies found on 64-row computed tomographic (CT) virtual hysterosalpingography (CT-VHSG) in the evaluation of the female reproductive tract in infertile patients. Material and Methods: We prospectively evaluated CT datasets from 209 patients with diagnosis of infertility. CT-VHSG was performed with a 64-row CT scanner using 64 x 0.625 mm(2) collimation and 0.9 mm slice thickness. A total volume of 20 mL of an iodine contrast dilution was injected into the uterine cavity. The duration of the CT scan and the grade of patient discomfort of the procedure were documented. Images were analyzed on a workstation. The CT-VHSG exams were divided in studies with normal or pathological findings; pathologies were classified according to their locations (cervical, uterine, and fallopian tube pathology). Results: No complications occurred during the procedure. The mean scan time was 3.4 +/- 0.4 s; the mean patient effective dose was 2.58 +/- 0.75 mSv. In relation to the patient's discomfort evaluation, 55.5% of the patients referred no discomfort during the procedure. Cervical pathology was found in 100/209 patients, uterine pathology in 93/209 patients, and fallopian tubes pathology in 37/209 patients. Conclusion: A 64-row CT-VHSG provides a reliable, non-invasive alternative diagnostic technique in the infertility workup algorithm. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the introduction of nurse hysteroscopists on patient satisfaction at an outpatient hysteroscopy clinic in the United Kingdom. Methods: Satisfaction with outpatient hysteroscopy performed in a University Teaching Hospital was measured using an anonymous structured questionnaire in 2000 and 2005. The unpaired t test, Mann-Whitney U test, or chi(2) test was used depending on the level of measurement. Results: A total of 102 women surveyed in 2005 were compared with 139 women surveyed in 2000. Age, ethnicity, perceived health status, previous satisfaction with outpatient appointments, and expectations of the appointment did not differ between the groups. Waiting time for an appointment and once at the clinic fell during the study period (P<0.001); satisfaction increased with the former (P<0.001), but not the latter (P=0.25). Satisfaction with the professional skills of healthcare providers and overall satisfaction was 95% or greater in both years. Conclusion: High levels of patient satisfaction with outpatient hysteroscopy were maintained after the introduction of nurse hysteroscopists. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the role of three-dimensional transvaginal ultrasound in diagnosing endometrial cancer in patients with history of postmenopausal bleeding and compare its effectiveness with two-dimensional ultrasound. Methods: Transvaginal ultrasound examinations, diagnostic hysteroscopy with subsequent curettage, and/or hysterectomy were performed in 213 consecutive patients with a history of postmenopausal bleeding. The results of the ultrasonographic examinations were compared with the diagnoses on the basis of histologic examination. In addition to an explorative data analysis, receiver operating characteristic curves were shown and areas under curves were calculated. Minimal endometrial volume (2.7 ml) and minimal endometrial thickness (7 mm) of endometrial carcinoma were defined as optimal cutoff values. Results: In 42 patients, endometrial carcinoma was diagnosed. The mean endometrial volume of patients with endometrial cancer, measured by three-dimensional ultrasound, was 11.78 ml. The sensitivity of the endometrial volume at the optimal cutoff (2.7 ml) was 100.00%, the specificity was69.00%, the positive predictive value was 44.20%, and the negative predictive value was 100.00%. On two-dimensional ultrasound, the mean endometrial thickness of patients with endometrial cancer was 16.6 mm. The sensitivity endometrial thickness measurements at the optimal cutoff (7 mm) was 100.00%, the specificity was 43.3%, the positive predictive value was 30.2%, and the negative predictive value was 100.00%. The area under curve of volume measured by three-dimensional ultrasound was 0.89 (95% CI 0.85–0.93). The area under curve of endometrial thickness was 0.85 (95% CI 0.80–0.91). The comparison of the area under curve of receiver operating curves between endometrial volume and endometrial thickness revealed a significant difference (p =0.023). Conclusion: Volume measurement by three-dimensional transvaginal ultrasound has a higher specificity, which means that it has the ability to better identify the negative cases compared to conventional ultrasound. Three-dimensional transvaginal ultrasound is a helpful tool for diagnosing endometrial cancer in patients with postmenopausal bleeding. [Copyright &y& Elsevier]

Background: Uterine perforation and false passage are occasional complications of operative hysteroscopy. Case Report: A 76-year-old woman underwent an operative hysteroscopy owing to postmenopausal bleeding and suspicious ultrasonographic intracavitary findings. A false passage through the wall of the cervix, created by the cervical dilators, was apparent upon the introduction of the hysteroscope. Bipolar coagulation employed to arrest bleedings led to the transection of the uterine artery. As no further bleeding ensued, the procedure was completed by resecting an endometrial polyp. Conclusions: Inadvertent injury to the uterine artery may further complicate false passage or perforation at hysteroscopy, underscoring the cautious usage of electocautery. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the occurrence of postmenopausal bleeding in women diagnosed with endometrial thickness. The study was carried out to 318 women diagnose with first episode of postmenopausal bleeding and endometrial thickness greater than four millimeters and does not undergo hormone replacement therapy. The study reveals that women with postmenopausal bleeding and endometrial thickness has a 20% chance of recurrence rate which is not associated with hysteroscopy.

Objective: To elaborate a strategy of endometrial follow-up for premenopausal women treated with Tamoxifen as adjuvant hormonal treatment of breast cancer. Patients and methods: Retrospective study of 152 premenopausal patients treated with Tamoxifen in Nantes Comprehensive Cancer Center for a breast cancer from January 2003 to December 2005. Vaginal sonography was used in the follow-up of 70 of them. Results: Endometrial hypertrophy was found in 26 patients. Sonohysterography and hysteroscopy allowed to find 11 polyps and three hyperplasias in the 19 women who were investigated. In our study, endometrial pathology was found in 20% of premenopausal women treated with Tamoxifen (polyps or hyperplasia). Uterine bleeding was found in half patient of this group. Discussion and conclusion: Vaginal sonography monitoring could be proposed to premenopausal women treated with Tamoxifen among whom endometrial pathology is usual. [Copyright &y& Elsevier]

Abstract: Study objective: To compare 2 procedures for metroplasty: resectoscopy with monopolar knife versus small-diameter hysteroscopy fitted with a Versapoint device. Design: Prospective randomized study (Canadian Task Force classification I). Setting: Endoscopic gynecology units at tertiary care university hospitals. Patients: One hundred-sixty patients with septate uterus and a history of recurrent abortion or primary infertility undergoing hysteroscopic metroplasty from 2001 to 2005. Interventions: Hysteroscopic resection of the uterine septum performed with either a 26F resectoscope with unipolar knife (80 women, group A) or a 5-mm diameter hysteroscope with Versapoint device (80 women, group B). All patients were managed expectantly, with follow-up lasting 1 year. Measurements and main results: Operative parameters (operative time, fluid absorption, complications, need for second intervention) and reproductive outcome parameters (pregnancy, abortion, term and preterm delivery, modality of delivery, cervical cerclage) were measured. Operative time and fluid absorption were significantly greater in group A than in group B (23.4 ± 5.7 vs 16.9 ± 4.7 minutes and 486.4 ± 170.0 vs 222.1 ± 104.9 mL, respectively). The cumulative complication rate was significantly lower in group B than in group A. No difference in any of the reproductive parameters was observed between the 2 groups: pregnancy and delivery rates were 70% and 81.6% in group A vs 76.9% and 84% in group B. Nine women (18.4%) from group B and 8 women (16%) from group B experienced spontaneous abortions. Most patients (54/82) delivered by cesarean section without differences according to the hysteroscopic technique used for metroplasty (65% in group A vs 67.7% in group B) or to the gestational age (65.1% of term and 68.7% of preterm deliveries). Conclusions: Small-diameter hysteroscopy with bipolar electrode for the incision of uterine septum is as effective as resectoscopy with unipolar electrode regarding reproductive outcome and is associated with shorter operating time and lower complication rate. [Copyright &y& Elsevier]

Abstract: This case report describes a new treatment of an isolated longitudinal vaginal septum (LVS) by office operative vaginoscopy with a 4-mm rigid hysteroscope in a 27-year-old virgin who reported leukorrhea and recurrent vaginal infections. This technique might represent an effective treatment of an LVS, mostly in patients with an intact hymen. This could allow the inclusion of vaginal lesions among the indications for office endoscopic procedures performed using operative hysteroscopes. [Copyright &y& Elsevier]

Abstract: Study objective: A key component of hysteroscopic complications, such as fluid overload and severe dilutional hyponatremia, is the failure to anticipate and quickly recognize fluid deficits. The purpose of this study was to measure the volume and mass of irrigation fluid bags to assess the overfill of 3 common types of hysteroscopy irrigation fluids, 0.9% normal saline solution, 3% sorbitol, and 1.5% glycine, to challenge the often-quoted standard of assumption that overfill may be as high as 10% of the bag’s volume. Design: Ten cases of irrigation fluid were tested. The volume and weight of drained fluid from 18 bags of 0.9% normal saline solution 2000 mL, 12 bags 3% sorbitol 3000 mL, 8 bags of 1.5% glycine 3000 mL, and 4 bags of 0.9% normal saline solution 5000 mL were measured. Institutional review board exemption was obtained. Measurements and main results: Ten cases of irrigation fluid were obtained. The volume and weight of drained fluid from 18 bags of 0.9% normal saline solution 2000 mL, 12 bags of 3% sorbitol 3000 mL, 8 bags of 1.5% glycine 3000 mL, and 4 bags of 0.9% normal saline solution 5000 mL were measured. By volume, varying by the type of fluid tested, the maximum observed overfill was between 3.3% to 5.0%. For confirmation, each bag was also weighed and found to have a maximum overfill between 2.8% to 5.6%, varying with the volume and type of fluid measured. These findings were then compared with the manufacturer-provided overfill range of 1.5% to 6.0%. No underfill was observed. Conclusion: Contrary to assertions over the last 25 years that overfill is 10% or higher as a rule, it appears more reasonable to assume that the degree of overfill is contingent on the type and volume of fluid used and is more likely closer to 2.8% to 5.6%. Therefore an accurate collecting system and weight measurement is more precise. [Copyright &y& Elsevier]

Abstract: Hysteroscopy today represents 200 years of salient innovations in instrumentation, new clinical applications for existing instruments, and continual modification of techniques, all aiming at observing, diagnosing, and treating pathologic conditions of the uterine cavity. Pioneers established the fundamental principles of intrauterine observation that steady technological advances would simplify and refine, all the way to the instrumentation and ancillary equipment now in use. Homage should be given and tribute paid to predecessors who made instrumentation, intrauterine distention, and illumination safe and practical for diagnostic and therapeutic hysteroscopy. Their accomplishments are remembered as we look with optimism to the many advances that undoubtedly will mark the future of hysteroscopy. [Copyright &y& Elsevier]

Contents The aim of present study was post-mortem examination of ovaries, uterus and plasma oestradiol-17 β (E2) and progesterone (P4) concentrations in the blood of sows with reproductive disturbances and the distribution of oestradiol receptor (ER α), as well as progesterone (PR-A) in the anoestrous sows uteri. Reproductive organs of 150 crossbred sows (Lithuanian White × Danish Landrace) culled for the reasons of reproductive disturbances, were collected in local abattoir over a period of 3 months (September–November). Organs were assessed to determine the stage of the oestrous cycle or anoestrus and their development. Blood samples were collected for E2 and P4 analysis from the jugular vein 1 h prior to slaughter. For this study uterine samples only from pathological anoestrous sows were subjected to immunohistochemical staining to assess the distribution of ER α and PR-A in surface epithelium, subepithelial connective tissue, glandular epithelium and myometrium. Macroscopic examination of the ovaries showed that 68.7% sows had active cycling ovaries, 26.6% sows were anoestrus, ovaries were small without CL, and 4.7% of sows had multiple follicular cysts. In anoestrous sows (n = 27) the number and intensity of the nuclear staining of ER α varied between different uterine tissue compartments. The highest number (>80%) and the strongest intensity (+++) of positively stained cells for ER α was seen in myometrium and glandular epithelium. In other uterine wall compartments the number and intensity of positively stained for ER α nuclei was lower (+/++). The PR-A was absent from all tissue compartments. The intensity of the nuclear staining for ER α varied not only between the different uterine compartments but also between the sows. The 11.1% of the sows presented ER α in surface epithelium, 74.1% of the sows in glandular epithelium and 63.0% of sows in the myometrium. [ABSTRACT FROM AUTHOR]

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Abstract: Study objective: To evaluate the benefits of adopting 3 simple “diagnostic criteria” in the differential diagnosis between septate and bicornuate uteri, and the relative treatment by hysteroscopy in an office setting. Design: Prospective clinical study (Canadian Task Force classification III). Setting: University-affiliated hospital. Patients: Two hundred-sixty patients with a hysteroscopic diagnosis of a double uterine cavity were enrolled. Interventions: Office hysteroscopic metroplasty was performed without analgesia or anesthesia using 5F scissors. Measurements and Main Results: The presence of vascularized tissue, sensitive innervation, and the appearance of the tissue at the incision of a supposed septum during an office hysteroscopic procedure were the criteria used to differentiate a septate from a bicornuate uterus. In 93.1% of the cases, office hysteroscopic metroplasty was successfully performed during the same diagnostic procedure. In 15 of 18 patients scheduled for laparoscopic control of the uterine anatomy, the suspicion of a bicornuate uterus was confirmed. Hysteroscopic follow-up at 3 months showed a regular uterine cavity with a fundal notch less than 1 cm. Conclusion: The study demonstrates the possibility of obtaining complete, safe removal of uterine septae in most cases by office hysteroscopy confirmation, using mechanical instruments, in an office setting. This was achieved by relating the diagnosis and treatment to simple anatomic and physiologic diagnostic criteria. [Copyright &y& Elsevier]

Most uninfected children born to diagnosed HIV-infected women are now exposed to antiretroviral therapy (ART) in utero and neonatally and concerns have been raised over the safety of this exposure. To explore parents' and health professionals' views on the long-term follow-up of uninfected children two related surveys were conducted in the UK. Questionnaires were completed by 140 parents/carers and 40 health professionals. Most of the respondents in both surveys (96% overall) acknowledged that it was important to follow up children to identify possible side effects from ART exposure. Almost all respondents (99%) found at least one of the strategies acceptable: follow-up through the clinic, by telephone, post or using data linkage. A third of parents and nearly half of health professionals strongly objected to at least one strategy, mostly postal and clinic contact respectively. The majority of parents (98%) thought they should be told if a potential health risk associated with ART exposure was identified; 73% of parents wanted any direct contact to be through them even when the child had grown up. Almost all respondents were supportive of the rationale for follow-up and, while expressing a preference for certain strategies, generally did not dismiss others. However, developing a single form of long-term follow-up which is both acceptable and feasible is challenging. [ABSTRACT FROM AUTHOR]

This study evaluated the ability of hysteroscopy to preoperatively predict cervical involvement in endometrial cancer. The records of 110 surgically staged consecutive endometrial cancer patients treated at our institution from 1997 to 2003 were retrospectively analyzed. Data on demographics, preoperative staging procedures, surgical pathology reports, and adjuvant treatments were retrieved. Fourteen (12.7%) patients had cervical involvement (stage II) according to the surgical pathology report, of whom nine (8.1%) had stage IIA and five (4.6%) had stage IIB. Clinical evaluation by speculoscopy and palpation had failed to reveal any indication of cervical involvement. Preoperative diagnostic hysteroscopy procedures were included. None of the hysteroscopy procedures revealed any suspicious lesion in the cervical canal. Hysteroscopy and clinical examination fail to adequately predict cervical involvement in endometrial carcinoma. Fractional D&C appears to be the best method until a more effective alternative becomes available. [ABSTRACT FROM AUTHOR]

To analyze hysteroscopic appearance of benign and malignant endometrial lesions in order to identify patterns to estimate the risk of malignance. Matched case–control study; two controls per case. The cases were 21 women (age range 40–90 years, median 63) with histologically confirmed endometrial malignancy, and the control group 42 women submitted to diagnostic hysteroscopy for benign lesions (age range 37–81 years, median 57). Hysteroscopic findings associated with malignancy were papillary aspect (OR 26.0, 95%CI 6.4–105.3), size > 1/2 uterine cavity (OR 22.0, 95%CI 5.1–95.8), irregular surface (OR 8.0, 95%CI 2.7–23.2), mixed color (OR 10.0, 95%CI 3.6–28.0), diffuse vascular arrangement (OR 5.3, 95%CI 1.3–21.5), little branched vessels (OR 15.0, 95%CI 3.0–74.9), and discordance between the main vascular axe and the direction of the lesion growth (OR 37.0; 95% CI 10.7–128.3). Ulcerated surface and anarchic vascular aspect were present only in malignant cases. The analyzes of general aspect, size, surface, color, vascular arrangement and vascular aspect allowed the estimation of the risk of malignancy, and the identification of points for targeted sampling. [ABSTRACT FROM AUTHOR]

Hematometra is a condition of retained blood or clot in the uterus. If just the cervix is affected by collection, the condition is described as hematocervix. The hematocervix should be suspected in a women with amenorrhea and recurrent lower abdominal pain. The objective of this case report was to report a rare case of isolated hematocervix following cesarean delivery. A 27-years-old primigravidae woman was admitted with the complaints of severe pelvic pain and amenorrhea. She had the history of full term delivery via cesarean section because of prolonged latent phase of labor almost 3 months ago. Pelvic examination, transvaginal sonography and MRI findings were confirmed the diagnosis of hematocervix cervical dilatation and curettage following vaginal misoprostol was done and the women was discharged with good health status. The increased rates of cesarean delivery in all over the world caused increase in rare complication such as isolated hematocervix. Dilatation and drainage of cervical collection is safe and effective treatment in such cases. [ABSTRACT FROM AUTHOR]

The term hysteroscopy is used to determine the procedure during which an endoscopic view of the endometrial cavity is achieved with the help of a type of endoscopic device called “the hysteroscope.” Hysteroscopy is used to assist the diagnosis for a series of female pathology. Apart from its diagnostic value, hysteroscopy can also be used for operative procedures including ablation and resection. Both diagnostic and operative hysteroscopy have been used for a number of years and various studies have been published to describe their success and complication rates throughout this period. Diagnostic hysteroscopy is relatively safe, whereas complications occur more frequently when operative hysteroscopy is used. These complications include uterine perforation, hemorrhage, fluid overload, gas embolization, and hyponatremia. The rate in the appearance of these complications is dependent on the type of the hysteroscopic procedure, the distending medium, and the experience of the hysteroscopist. To avoid any problems concerning the application of hysteroscopic procedures, it is important to take the necessary precautions both preoperatively and intraoperatively. For example, the preoperative use of thinning agents of the endometrium and the reduction of the operating time, or the avoidance of cutting too deeply into the myometrium, are some of the parameters to be considered when hysteroscopy is in argument. [ABSTRACT FROM AUTHOR]

BACKGROUND: A randomized, controlled study was performed to compare vaginoscopic versus traditional (speculum with or without tenaculum) hysteroscopy in terms of pain score and procedure time. METHODS: Three hundred patients were randomized in two groups: Group A, diagnostic hysteroscopy with vaginoscopic approach (150 patients) and Group B, diagnostic hysteroscopy with traditional approach (150 patients). All procedures were performed using a semi-rigid 3.5-mm minihysteroscope with a 0° grade optic. Patients of each group were divided into three subgroups according to their reproductive status: fertile nulliparous (FN), fertile multiparous (FM) and post-menopausal (MEN) women. Women were asked to rate their degree of pain during four phases of the procedure: introduction of hysteroscope (Group A) or speculum (Group B) into the vagina (Phase I) and progression through cervical canal up to internal uterine orifice (IUO) (Phase II), inspection of uterine cavity (Phase III) and performing of endometrial biopsy (Phase IV). A total pain score was calculated for each group. For each patient, the duration of hysteroscopy was recorded from the introduction to the extraction of the scope (Group A) or of the speculum (Group B). RESULTS: Although the median total pain scores were 2 in each group, the 95% confidence interval for vaginoscopic hysteroscopy (1.86–2.01) was significantly (P < 0.05) lower than that for traditional hysteroscopy (2.10–2.26). Comparison between the corresponding phases of the procedure showed the only significant difference during Phase I of the procedure [Group A: 1 (95% CI 1.0–1.18) versus Group B: 2 (95% CI 2.3–2.8); P < 0.05]. No significant differences in terms of duration of the procedure were observed between the two approaches. CONCLUSIONS: When surgeons using vaginoscopic hysteroscopy with a semi-rigid minihysteroscope were compared with those using traditional approach and the same instrumentation, the operating times and the patients’ pain scores were similar. [ABSTRACT FROM AUTHOR]

The article reports on the use of sonohysterography and office hysteroscopy in diagnosing submucous myomas. It states that accurate diagnosis of the disease can aid in determining the surgical technique that fits the condition thus avoiding complications while hysteroscopic treatment prevents the need for a major surgical procedure.

The aim was to assess the endocervical and endometrial damage inflicted by embryo transfer trial using office hysteroscopy. Seventy-five consecutive infertile women who underwent office hysteroscopy were enrolled. Hysteroscopy was performed immediately after embryo transfer trial. The relationship between clinical perception of easiness of transfer, presence of blood on the catheter, degree of endocervical and endometrial damage was examined. In the difficult transfer group, minor and moderate endocervical lesions were noted in 35% and 24% of the cases, respectively. The respective figures for the easy transfer group were 19% and 3% (P > .05). There was a statistically significant concordance between the perceived difficulty of transfer and degree of endometrial damage (P < 0.05). Of interest, in the easy transfer group, 32% of the patients had minor, 3% moderate and 65% no endometrial damage. The respective figures were 42%, 29% and 29% in the difficult transfer group. There was blood on the catheter in 25%, 56% and 71% of the easy, moderate and difficult transfer groups, respectively. There was a statistically significant concordance between the perceived difficulty of embryo transfer and presence of blood on the catheter (P < 0.05). These results suggest that clinical perception of difficulty of transfer and the presence of blood on the catheter are directly associated with endometrial disruption. [ABSTRACT FROM AUTHOR]

The article compares a “no touch” approach to diagnostic hysteroscopy without anesthesia with traditional diagnostic hysteroscopy after intracervical injection of mepivacaine hydrochloride 3 percent. Less pain was reported by patients under the altered approach to diagnostic hysteroscopy. The complete elimination of any type of premedication, analgesia or anesthesia has been permitted by the technique. The use of vaginoscopy over the traditional method is supported by the findings.

Objective To evaluate outpatient versus daycase endometrial polypectomy by comparing success rate, complications, patient tolerance, pain score, analgesia requirement and recovery. Design A randomised controlled trial. Setting A large UK Teaching hospital. Population Forty consecutive women diagnosed with an endometrial polyp at outpatient hysteroscopy were randomly assigned in equal proportions to outpatient or daycase polyp removal. Methods The outpatient cohort underwent endometrial polypectomy either using grasping forceps or a bipolar electrode (Versapoint™; Gynecare Inc., Menlo Park, CA, USA) introduced down the operating channel of a rigid hysteroscope (Versascope™; Gynecare Inc.). The daycase cohort underwent traditional endometrial polyp resection using a hysteroscopic, monopolar, electrosurgical resecting loop, performed under general anaesthetic. Main outcome measures The main outcome measures were as follows: success rates and intra or postoperative complications, time away from home, analgesia requirements, pain scores on the day of and one day after endometrial polypectomy, return to work and preoperative fitness and preference for the location of a future endometrial polypectomy. Results The majority of women from both cohorts were premenopausal (62.5%), parous (85%) and in paid employment (62.5%). One woman allocated to outpatient polypectomy had cervical stenosis and dilatation was unsuccessful in the outpatient setting. There were no other intra or postoperative complications in either arm of the study. The mean intraoperative visual analogue style (0–100 mm) pain score during outpatient polypectomy was 23.7 mm (1–62). A proportion of women (20%) described no intraoperative discomfort; however, the majority (75%) described mild or moderate intraoperative discomfort. More women in the outpatient cohort (58%) described themselves as pain free for the remainder of the day than in the daycase cohort (28%) ( P= 0.09). The day after the procedure, all women from the outpatient group described slight or no discomfort compared with only 41% of women from the daycase group ( P= 0.02). All women undergoing outpatient polypectomy had a significantly shorter mean time away from home (3.24 [1.5–5] hours) than women undergoing daycase polypectomy (7.42 [6–10.5] hours), P < 0.0005. Similarly, women from the outpatient cohort had a significantly faster mean return to preoperative fitness (1 [0–4] day versus 3.2 [1–13] days; P= 0.001) and required less postoperative analgesia than the daycase cohort. Ninety-five percent of women from the outpatient cohort and 82% of women from the daycase cohort stated they would prefer to undergo an endometrial polypectomy in the outpatient setting should they require a further polyp removal. Conclusion Endometrial polypectomy can be successfully performed in the outpatient setting with minimal intraoperative discomfort, a significantly shorter time away from home and faster recovery and is preferred by women when compared with daycase polypectomy. Resources need to be made rapidly available to undertake larger scale research and develop this service across the UK. [ABSTRACT FROM AUTHOR]