OBJECTIVE: Recent advances in laparoscopic surgery have allowed to substitute Laparoscopic Assisted Vaginal Hysterectomy for classical abdominal hysterectomy. The purpose of this study was to evaluate the effectiveness and the value of hysteroscopic procedure which was helpful in taking directed biopsies of malignant suspected areas of endometrium before LAVH. METHODS: We compared hysteroscopic biopsy results with permanent biopsy results after LAVH in 100 patients (group A). In addition, we considered hysteroscopic biopsy results of 60 patients (group B) who had abnormal endometrial findings in vaginal ultrasonography. RESULTS: No endometrial malignant lesion was found between hysteroscopic biopsies and permanent pathologic results after LAVH in the study group A. The malignant hysteroscopic biopsy results of the study group B was about 25%. CONCLUSION: Hysteroscopic procedure for detecting endometrial malignant lesion before LAVH in large uterine tumors could be used. But this study provided that preoperative vaginal sonography was sufficient to evaluate endometrial condition.
Biopsy ; Endometrium ; Female ; Humans ; Hysterectomy ; Hysterectomy, Vaginal* ; Hysteroscopy* ; Laparoscopy ; Ultrasonography

In order To evaluate whether the parameters of spiral artery blood flow, as measured by transvaginal color Doppler, may be used to assess endometrium receptivity prior to embryo transfer (ET), a retrospective study of 94 infertile women who had undergone ART treatments with different outcomes (pregnant or nonpregnant) was done. Subendometrial blood flow was evaluated. The resistance index (RI), systolic/diastolic ratio (S/D) and pulsatility index (PI) were significantly lower in those who achieved pregnancy as compared with those who did not: 0.62+/-0.04 vs 0.68+/-0.04 (P<0.001), 2.66+/-0.33 vs 3.19+/-0.39 (P<0.01) and 1.15+/-0.17 vs 1.34+/-0.22 (P<0. 05), respectively. Furthermore, when RI>0. 2, PI>1. , and S/D>3. , no pregnancy occurred. These data suggest that the parameters of spiral artery blood flow could be used as a new assay in predicting endometrial receptivity before ET.
Arteries/ultrasonography ; Embryo Implantation/*physiology ; Embryo Transfer ; Endometrium/*blood supply ; Endometrium/*physiology ; Endometrium/ultrasonography ; Fertilization in Vitro ; Infertility, Female/physiopathology ; Regional Blood Flow ; Sperm Injections, Intracytoplasmic ; Treatment Outcome ; Ultrasonography, Doppler, Color

This study was conducted to evaluate the effects of induced endometritis on uterine blood flow in cows. Transrectal Doppler sonography was performed on uterine arteries of six cyclic cows before and for 4 days after inducing acute endometritis by intrauterine infusion of 720 mg of policresulen, and for 4 days of the following estrous cycle. Time-averaged maximum velocity (TAMV) increased (p < 0.001) and pulsatility index (PI) decreased (p < 0.0001) within 1 h of policresulen administration, and did not change (p > 0.05) in the next 4 days of the same cycle. TAMV and PI values in the subsequent cycle did not differ (p > 0.05) from the values measured before infusion and showed no changes (p > 0.05) within the cycle. Blood flow parameters were not related (p > 0.05) to plasma concentrations of progesterone and estrogen. All cows showed an acute endometritis determined by histopathological findings of biopsy samples taken 1 day after infusion and fibrotic endometrial alterations detected in the subsequent cycle. No relationships were observed between fibrotic changes of the endometrium and uterine blood flow during either cycle. In conclusion, acute inflammation is accompanied by a rise in uterine blood flow, but fibrotic alterations do not seem to be related to Doppler sonographic findings.
Biopsy ; Endometritis* ; Endometrium ; Estrogens ; Estrous Cycle ; Female ; Inflammation ; Plasma ; Progesterone ; Ultrasonography ; Uterine Artery

OBJECTIVE: The aim of our study is to determine clinical factors and sonographic findings associated with endometrial hyperplasia or cancer (EH+) in premenopausal and perimenopausal women. METHODS: A total of 14,340 transvaginal ultrasonography examinations of 9,888 healthy premenopausal and perimenopausal women were included in this retrospective study. One hundred sixty-two subjects underwent endometrial biopsy based on abnormal uterine bleeding (AUB), sonographic endometrial abnormalities (thickened endometrium, endometrial mass, or endometrial stripe abnormality), or both. The clinical factors and sonographic endometrial abnormalities were evaluated with regard to EH+. RESULTS: Histologically verified EH+ was found in fourteen subjects (8.6%); ten cases of endometrial hyperplasia (EH) without atypia, three cases of EH with atypia (AEH), and one case of endometrial cancer. Neither clinical factors nor AUB were associated with EH+ (P=0.32) or AEH+ (P=0.72). Of sonographic findings, endometrial stripe abnormality was significantly associated with EH+ (P=0.003) and marginally associated with AEH+ (P=0.05), but a thickened endometrium was not associated with EH+ (P=0.43). CONCLUSION: Endometrial stripe abnormality is a significant factor to predict EH+ in healthy premenopausal and perimenopausal women with and without AUB. However, simple measurement of endometrial thickness has a limited role in this capacity.
Biopsy ; Diagnosis ; Endometrial Hyperplasia* ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Mass Screening* ; Retrospective Studies ; Ultrasonography* ; Uterine Hemorrhage

Malignant mixed mllerian tumors (MMMTs) are unusual neoplasms occurring mostly in the endometrium. In the ovary, they are very rare and represent less than 1% of all ovarian malignancies. They are highly aggressive neoplasms comprising histologically of both epithelial and mesenchymal components. The cell type cannot be determined on the basis of appearance at magnetic resonance (MR) imaging, computed tomography (CT), or ultrasonography (US) but we diagnosed this case as endometrioid adenocarcinoma by MR imaging. Although the pathologic evaluation revealed the ovarian MMMT, mesenchymal components was very minute in the background of endometrioid adenocarcinoma components. The patient received the screening tests of ovarian carcinoma including transvaginal ultrasonography only 3months ago and she got negative results. During the exploration, a 15-cm sized mass looked like it has rapidly grown and ruptured spontaneously preoperatively. Herein we report a case of ovarian MMMT, which was diagnosed preoperatively as endometrioid adenocarcinoma by MR imaging with review of literatures.
Carcinoma, Endometrioid* ; Endometrium ; Female ; Humans ; Magnetic Resonance Imaging* ; Mass Screening ; Ovary* ; Ultrasonography

OBJECTIVE: The aim of this study was to describe the unique transvaginal sonographic(TVS) findings and clinical manifestations attributes of adult ovarian granulosa cell tumor(GCT) in postmenopausal women. METHODS: Data for 7 postmenopausal women with pathological proven adult ovarian GCT were respectively reviewed in Samsung Cheil Women's Hospital, between 1996 and 1999. Characteristics of transvaginal sonographic findings, pathological findings and clinical manifestations were analyzed. RESULT: On the basis of TVS findings, 7 cases of adult ovarian GCT were varied, but grossly categorized into 2 morphologic patterns: semisolid mass with scattered cystic components (n=3), muliticystic mass resembling typical hemorrhagic cyst (n=4). There are characteristics of TVS imaging of GCT that various size and stage of hemorrhage presents in the tumor. Endometrial transvaginal sonographic findings were normal atrophic EM (n=1), less than 5 mm with fluid collection (n=1), more than 5 mm with or without abnormal echogenicity (n=5). Clinical manifestations were, combination or alone, abnormal uterine bleeding (n=all), abdominal pain (n=1), mass palpation(n=3). Histopathologically most tumors were mixed, such as microfollicular, marcofollicular, trabecular pattern and also varied histologic appearance and tumor cell arrangement. CONCLUSION: TVS findings and combined presenting symptoms in postmenopausal women that raise suspicion of adult ovarian GCT include a relatively large ovarian mass (especially with hemorrhage) with a complex consistency, thickened endometrium and abnormal uterine bleeding without horomone replacement therapy. So it is possible to differentiate on basis of TVS imaging and symptoms between GCT and epithelial tumors of the ovary in postmenopausal women.
Abdominal Pain ; Adult ; Endometrium ; Female ; Granulosa Cell Tumor* ; Granulosa Cells* ; Hemorrhage ; Humans ; Ovary* ; Ultrasonography ; Uterine Hemorrhage

OBJECTIVE: To explore the association of estrogen receptor (ER) alpha gene PvuII and XbaI polymorphisms and ultrasonographic findings of uterine endometrium. METHODS: Forty-five postmenopausal women undergoing hormone replacement therapy (HRT) were included in this study. Women were evaluated for PvuII and XbaI polymorphisms for ER alpha gene after extracting DNA from peripheral blood. The thickness and appearance of uterine endometrium was measured by transvaginal ultrasonography. The association of estrogen receptor gene PvuII and XbaI polymorphisms and ultrasonographic endometrial findings were analyzed. RESULTS: No statistically significant difference was found in endometrial thickness (pp 3.6 +/- 1.5 mm, Pp 4.2 +/- 1.6 mm, PP 3.5 +/- 1.3 mm) or endometrial appearance among the three different groups by PvuII polymorphism. No significant difference was also observed in endometrial thickness (xx 3.6 +/- 1.5 mm, Xx 4.2 +/- 1.4 mm) or endometrial appearance between the two groups of different XbaI genotypes. CONCLUSION: These results suggest that neither PvuII nor XbaI polymorphism of the estrogen receptor alpha gene may be associated with the ultrasonographic findings of uterine endometrium in postmenopausal women undergoing HRT. Further studies with a larger scale are necessary to confirm these data.
DNA ; Endometrium* ; Estrogen Receptor alpha ; Estrogens* ; Female ; Genotype ; Hormone Replacement Therapy* ; Humans ; Ultrasonography

OBJECTIVE: To determine the effects of a selective estrogen receptor modulator (SERM), raloxifene, on endometrium in postmenopausal women. METHODS: Double-blind randomized controlled study was designed for 138 healthy postmenopausal women to determine the effects of raloxifene on postmeonopausal endometrium. The women were randomly assigned to receive either placebo, or raloxifene HCl 60 mg/day for 6 months. Transvaginal ultrasound was done at baseline and at 6 months later. RESULTS: Mean endometrial thickness of normal postmenopausal women was 3.4 ( +/- 1.6) mm. Mean endometrial thickness was decreased by 0.2 mm in both groups, but with no statistical significance. CONCLUSION: Raloxifene 60 mg/day did not stimulate the endometrium after 6 months of use in postmenopausal women.
Endometrium* ; Female ; Humans ; Postmenopause ; Raloxifene Hydrochloride* ; Selective Estrogen Receptor Modulators ; Ultrasonography

OBJECTIVE: The aim of this study is to investigate the effect of tamoxifen on endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer after chemotherapy. METHODS: Fifty-eight tamoxifen-treated postmenopausal breast cancer patients underwent periodically transvaginal ultrasonography twice a year for 2 years and then once a year. We analyzed the correlation between the sonographic endometrial thickness and the duration of tamoxifen therapy. RESULTS: The mean endometrial thickness of breast cancer patients before tamoxifen therapy was 4.68 mm. But the mean endometrial thickness increased to 5.03 mm at 6 months, 5.21 mm at 12 months, after which it slightly declined to 5.13 mm at 18 months. And then it increased to 5.15 mm at 24 months, and 5.24 mm at 36 months. There was a significant increase in endometrial thickness after tamoxifen therapy compared with before tamoxifen therapy (p<0.05). Overall, proliferative endometrium was the most common histopathologic finding (5/14) in tamoxifen-treated postmenopausal women who had endometrial thickness >or=5 mm. No cases of endometrial cancer were detected. CONCLUSION: Significant increase in endometrial thickness with the duration of tamoxifen therapy in postmenopausal tamoxifen-treated patients may be associated with a high risk of endometrial pathologies in these patients.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Endometrial Neoplasms ; Endometrium ; Female ; Humans ; Pathology ; Tamoxifen ; Ultrasonography

OBJECTIVETo evaluate the effect of trial transfer on embryo transfer.

METHODSEmbryo transfer guided by ultrasound was performed in 114 cycles. And trial transfer was accomplished in 101 of them prior to embryo transfer. The clinical pregnancy rate and embryo implantation rate were compared between the group with trial transfer and the group without, and also among the sub-groups formed according to the difference between the trial transfer position and the actual embryo depth.

RESULTSThere was no statistically significant difference in the clinical pregnancy rate and embryo implantation rate between the group with trial transfer and that without trial transfer(59.41% vs 61.54%, 35.81% vs 31.43%, P > 0.05), nor was there between the two subgroups of the group with trial transfer (61.54% vs 58.67%, 40.79% vs 34.09%, P > 0.05).

CONCLUSIONAs far as modern embryo transfer techniques are concerned, trial transfer can not provide accurate guidance for the depth of embryo transfer.

Adult ; Embryo Transfer ; Endometrium ; diagnostic imaging ; Female ; Fertilization in Vitro ; methods ; Humans ; Middle Aged ; Pregnancy ; Ultrasonography