Comparison of Laparoscopic Ovarian Drilling Success between Two Standard and Dose-Adjusted Methods in Polycystic Ovary Syndrome: A Randomized Clinical Trial

Background

One of the treatment methods for increasing the ovarian response to ovulation induction in polycystic ovary syndrome (PCOS) is laparoscopic ovarian drilling (LOD). The optimal amount of the electrosurgical energy discharged in the ovaries to achieve maximum treatment response with minimal follicle injury is unknown. This study was performed to compare the success level of LOD by means of standard and dose-adjusted treatment methods among infertile clomiphene-resistant PCOS women.

Materials and Methods

This randomized clinical trial was conducted on infertile clomiphene citrate-resistant PCOS women in the Gynaecology Department of Imam Reza Hospital between 2016 and 2017. The patients were randomly di- vided into two groups based on the ovarian cautery method. The two groups were examined and compared regarding the antral follicles, the serum levels of anti-Müllerian hormone (AMH), androgens, and mid-luteal progesterone one month after surgery. The regularity of cycles, ovulation, and pregnancy were examined monthly up to six months after surgery.

Results

In total, 60 women received bilateral LOD (n=30 per group). The level of AMH (P=0.73), testosterone (P=0.91), and dehydroepiandrosterone sulphate (DHEAS, P=0.16) did not differ at study entrance and one month after ovarian cautery [P=0.94 (AMH), P=0.46 (testosterone), and P=0.12 (DHEAS)] and for postoperative mid-luteal pro- gesterone (P=0.31). Intragroup comparisons showed a statistically significant difference in the decrease in the number of antral follicles and testosterone in the standard group (P=0.02) and AMH level in the cautionary dose-adjusted group (P=0.04). We observed no difference in cycle regularity (P=0.22), ovulation (P=0.11), and pregnancy (P=0.40) between the two groups after six months.

Conclusion

The results indicated that there was no difference between the two methods of ovarian cautery with re- gards to establishing cycle regularity and ovulation. The standard treatment was effective in decreasing the numbers of antral follicles and testosterone levels, whereas the dose-adjusted method significantly affected the decrease in AMH levels (Registration Number: IRTC20171210037820N1).

Diffusion Weighted Imaging in Acute Attacks of Multiple Sclerosis

Background

Multiple sclerosis (MS) is one of the most common autoimmune disorders of the central nervous system. In spite of various imaging modalities, the definitive diagnosis of MS remains challenging.

Objectives

This study was designed to evaluate the usefulness of diffusion weighted imaging (DWI) in the diagnosis of acute MS attack and to compare its results with contrast enhanced MRI (CE-MRI).

Patients and Methods

In this cross sectional study, seventy patients with definite diagnosis of relapsing-remitting MS were included. CE-MRI using 0.1 mmol/kg gadolinium as well as DWI sequences were performed for all patients. The percentage of patients with positive DWI was compared with the results of CE-MRI and the consistency between the two imaging modalities was evaluated. Moreover, the relationship between the time of onset of patient’s symptoms and test results for both methods were investigated.

Results

CE-MRI yielded positive results for 61 (87%) patients and DWI yielded positive for 53 (76%) patients. In fifty patients (71.42%), both tests were positive and in six cases (8.57%), both were negative. The test results of three patients turned out to be positive in DWI, while they tested negative in CE-MRI. There was no significant relationship between the results of CE-MRI as well as DWI and the time of imaging from the onset of symptoms.

Conclusion

These data indicate that while CE-MRI will depict more positive results, there are cases in which DWI will show a positive result while CE-MRI is negative. We suggest that the combination of these two imaging modalities might yield more positive results in diagnosing acute MS attack giving rise to a more accurate diagnosis.

Improvement of distension and mural visualization of bowel loops using neutral oral contrasts in abdominal computed tomography

AIM: To assess and compare the image quality of 4% sorbitol and diluted iodine 2% (positive oral contrast agent) in abdomino-pelvic multi-detector computed tomography.

METHODS: Two-hundred patients, referred to the Radiology Department of a central educational hospital for multi-detector row abdominal-pelvic computed tomography, were randomly divided into two groups: the first group received 1500 mL of 4% sorbitol solution as a neutral contrast agent, while in the second group 1500 mL of meglumin solution as a positive contrast agent was administered in a one-way randomized prospective study. The results were independently reviewed by two radiologists. Luminal distension and mural thickness and mucosal enhancement were compared between the two groups. Statistical analysis of the results was performed by Statistical Package for the Social Sciences software version 16 and the Mann-Whitney test at a confidence level of 95%.

RESULTS: Use of neutral oral contrast agent significantly improved visualization of the small bowel wall thickness and mural appearance in comparison with administration of positive contrast agent (P < 0.01). In patients who received sorbitol, the small bowel showed better distention compared with those who received iodine solution as a positive contrast agent (P < 0.05).

CONCLUSION: The results of the study demonstrated that oral administration of sorbitol solution allows better luminal distention and visualization of mural features than iodine solution as a positive contrast agent.

Bronchial artery embolization as a treatment of hemoptysis induced by pulmonary metastasis from malignant melanoma

Lung metastasis is a rare cause of hemoptysis. Bronchial artery embolization is an effective intervention for treatment of hemoptysis with various underlying etiologies. A 28-year-old man with a known history of malignant melanoma in the neck from 6 years ago and lung metastasis from 1 year ago referred to the Emergency Department of our teaching hospital with the chief complaint of hemoptysis. Chest x-ray and pulmonary CT-scan showed multiple pulmonary nodules with different sizes in both lung parenchyma. The patient's hemoptysis did not resolve completely in spite of appropriate medical treatment. The patient was then referred to the endovascular unit of the vascular department in our hospital and underwent bilateral bronchial artery embolization. With this procedure his symptoms resolved completely and he was discharged after a week.

The effect of surveillance on the outcome of breast cancer patients

BACKGROUND

The beginning of metastasis poorly affects the prognosis of breastcancer patients. Lung is the most frequent site of visceral metastasis, and the rate of recurrence is 10-30%. We have tried to find out if the routine Chest X Ray (CXR) could play a role for early detection of lung metastasis, during the prognosis of these patients.

METHODS

The files of the breast cancer patients between 1996 to 2006 (1739 patients) have reviewed. Clinical characteristics of patients with pulmonary metastasis have recorded. Patients, who lacked imaging files or lacked an appropriate follow-up, have excluded. Data have analyzed by SPSS 11.5. The survival analyses have performed by using the Kaplan-Meier method.

RESULTS

Fifty-six patients, median age 46, have entered into this retrospective study. Median tumor size was 4cm; median number of Lymphadenopathy (LAP) was 4. The intermediate grade has detected in 74% of patients. All patients have received adjuvant treatment. Median time from cancer diagnosis to pulmonary metastasis was 22 months. Pulmonary metastasis has detected by control CXR in77.4% and patients' symptoms in 22.6%. Forty eight patients have received chemotherapy in metastatic phase. In 28 patients (50%), other sites of metastasis (bone, liver, and brain) have discovered.The most frequent pattern of lung recurrence was pulmonary nodule (44.6%), followed by pleural effusion (28.6%). Median survival was 27.5; median survival from pulmonary metastasis was 8 m.

CONCLUSION

Early detection of pulmonary metastasis by CXR did not affect patients' endpoints. None of the probable prognostic factors have shown a significant effect on patients' outcome. Despite systemic treatment, survival after metastasis is low.

(99m)Tc-labeled ubiquicidin scintigraphy: a promising method in hip prosthesis infection diagnosis

AIM

Hip prosthesis implantation has witnessed a significant increase in recent years. Despite the advantages of this surgical procedure, it has some complications, the most serious of which is prosthetic infection. This study was conducted to investigate the feasibility of 99mTc-UBI scintigraphy in detection of infectious foci in painful hip prosthesis. UBI (Ubiquicidin 29-41) is an antimicrobial peptide fragment with the ability to target the bacterial colony directly.

PATIENTS, METHODS

34 patients, aged 20-79 years, with painful hip prosthesis were included. 99mTc-UBI scan and three phase bone scan were performed and two nuclear medicine specialists interpreted the UBI scans with and without bone scan results at hand. Both qualitative and semi-quantitative methods were used to interpret the 30 minute post injection images. The patients were actively followed up. According to the surgical findings, microbiological culture and active follow up, final diagnosis was made.

RESULTS

24 negative and 10 positive UBI scans were recorded. The sensitivity, specificity, negative and positive predictive values and accuracy of the study were all 100%. Bone scan did not have any influence on UBI interpretation. We were able to achieve excellent differentiation between infected and non-infected prostheses with a cut off value of 1.8 for target to non target (T/NT) ratio. No adverse effects were noticed following UBI scan.

CONCLUSION

Based on the findings, the authors believe that 99mTc-UBI scintigraphy, with its high sensitivity and specificity, provides the physician with an excellent tool for differentiating infection from aseptic loosening of hip prostheses. Using this radiopharmaceutical, it is possible to obtain highly accurate results only 30 minutes after the beginning of the study.

Normal values of gallbladder ejection fraction using 99mTc-sestamibi scintigraphy after a fatty meal formula

BACKGROUND AND AIMS

Sincalide, in conjunction with cholescintigraphy, is necessary for the diagnosis of chronic acalculous cholecystitis. However sincalide is not widely available. This study investigates the use of a commercially available formula as an inexpensive alternative to sincalide, containing a sufficient and known amount of fat to cause gallbladder contraction, and to determine normal gallbladder ejection fraction (GBEF) values.

METHODS

We studied 36 patients aged 51.7+/- 10.9 years with body mass index 26.7+/- 5.2 who were referred for 99mTc-sestamibi myocardial perfusion imaging. They did not have any abdominal symptoms, or history of abdominal disease and were not taking any medication known to affect the biliary tract. All were prescreened with a hepatobiliary ultrasonography to exclude any abnormality. After 6 hours fasting, 20 mCi of 99mTc-sestamibi was injected intravenously at rest and 90 minutes later the subjects ingested a test meal (10 g fat). GBEF was calculated at 30 and 60 minutes after fatty meal ingestion.

RESULTS

GBEF at 30 minutes and at 60 minutes after fatty meal ingestion were 69.54+/- 21.04% and 84.26+/-11.41%, respectively. GBEF did not differ significantly between men and women. There was no statistically significant correlation between BMI and GBEF. No significant difference was noticed in GBEF between obese, overweight and normal weight patient groups.

CONCLUSION

Lower limit of normal GBEF values was 27.46% at 30 min and 61.44% at 60 min using a standard fatty meal. It is possible to report the results of a GBEF measurement after fatty meal in terms of the percentile rank, compared with subjects without biliary disease.