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Sonographic Diagnosis of Small Adnexal Masses: A Multi-Institutional Study
EGerardo Zanetta*
Enrico Ferrazzi**
Danilo Dordoni***
Andrea Lissoni*
Department of Obstetrics and Gynecology, San Gerado Biomedical Science Institute, Monza*,
Department of Obstetrics and Gynaecology, San Paolo Biomedical Science Institute, University of Milan, Milan**,
Department of Obstetrics and Gynaecology, University of Brescia, Brescia***, Italy.
Summary
- Transvaginal sonography (TVS) versus colour Doppler ultrasound for diagnosis of small adnexal masses was compared in this multi-institutional study.
- Malignant tumours had significantly higher TVS-derived morphological scores compared with benign masses (p = 0.001).
- Malignant tumours also had significantly lower impedance values on colour Doppler ultrasound compared with benign tumours, although the sensitivity and specificity of flow parameters was less than that of TVS-derived scores.
- TVS-based morphological scoring has a satisfactory sensitivity and specificity for the differential diagnosis of small adnexal masses.
- Flow parameters have inadequate sensitivity and specificity when considered alone, but integrating the results of colour Doppler ultrasound can add reliability to the positive predictive value of TVS-based morphological scores.
Editor's Comment
The results of this clinical research suggest that using a TVS-based morphological score (> 7) as an indication for surgery could appropriately limit surgical exploration in many women presenting with a suspicious presumed adnexal mass. In addition, colour Doppler ultrasound may be useful in decreasing the risk of missing malignancy in women obtaining low sonographic/morphologic scores.
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Changing Concepts in the Management of Chronic Pelvic Pain
Usha Gupta (Professor)
Department of Obstetrics and Gynaecology,
Lady Hardinge Medical College & Smt.
Sucheta Kriplani Hospital, New Delhi, India
Summary
- Chronic pelvic pain (CPP) may account for up to one-third of all gynaecological outpatient cases.
- Laparoscopy is a useful diagnostic modality in assessing CPP patients.
- Nearly one-quarter of CPP cases are the result of acute pelvic inflammatory disease (PID).
- A multi-disciplinary approach is advocated towards diagnosis and treatment of CPP.
- Surgery should be scheduled only if specifically indicated.
Editor's Comment
CPP presents a challenge to both patients and doctors. Effective management requires a multimodal approach. This includes a synergism of drug therapy, exercise programmes, diet and lifestyle modifications.
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Minilaparotomy Abdominal Hysterectomy A New Surgical Technique
iJ. B. Sharma (Associate Professor)
Department of Obstetrics & Gynaecology,
Maulana Azad Medical College,
New Delhi, India
Summary
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Clinical application of the minilaparotomy abdominal hysterectomy technique is reported in 15 women requiring surgery for menstrual dysfunction.
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Mean operating time for the minilaparotomy abdominal hysterectomy was 42 minutes and the mean loss of haemoglobin (Hb) 1 g/dL.
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Post-operative recovery was generally uneventful. Complications included a blood transfusion (1 case), pyrexia (1) vaginal discharge (2) and vault granulation tissue (1). No urinary or bowel problems were noted.
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Advantages of the minilaparotomy abdominal hysterectomy technique include ease of mastery (compared with laparoscopic surgery) and less-expensive equipment requirements.
Editor's Comment
In this clinical report, the author describes his initial experience with minilaparotomy hysterectomy. So far, this attractive new, easy to learn and inexpensive technique appears safe and feasible for selected patients, with results comparable to laparoscopic surgery.
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Newer Techniques in LSCS: the INHS Asvini Experience
K. G. Paul (Surgeon Commander) Rupali Naik (Doctor)
Department of Gynaecology & Obstetrics,
Indian Naval Hospital Ship (INHS) 'Asvini',
Colaba, Mumbai 400 005, India
Summary
- Two techniques for lower segment caesarean section (LSCS) were compared. The 'newer' procedure was based on the modified Joel-Cohen method of opening the abdomen, suturing of the uterus in one layer and non-closure of visceral and parietal layers; the 'reference' (previous standard) procedure comprised a Pfennenstiel incision, the uterus sutured in two layers and complete repair of visceral and parietal peritoneum.
- 509 operations were completed over a 3-year period.
- Results indicated that the newer technique was advantageous in terms of surgical time and reduced blood loss.
- There were no significant differences in post-operative recovery or morbidity between the two procedures.
- There were no significant differences in post-operative recovery or morbidity between the two procedures.
- The newer technique is now being used as the standard procedure for LSCS at the INHS 'Asvini'.
Editor's Comment
Caesarean section remains a vital part of modern-day obstetric practice. LSCS is the most commonly performed procedure, often as an emergency operation. In this study, authors at the INHS 'Asvini' report their assessment of two different LSCS techniques, their aim being to establish a new standard procedure for their institution.
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