Curettage In Patients Research Articles

Обґрунтування доцільності проведення закритого кюретажу у пацієнтів з генералізованим пародонтитом II ступеня тяжкості, асоційованого з персистуючою герпесвірусною інфекцією

У статті розглянуто доцільність проведення методики закритого кюретажу у пацієнтів з генералізованим пародонтитом (ГП) II ступеня тяжкості, асоційованого з персистуючою герпесвірусною інфекцією (ГВІ). Проведено ретроспективний аналіз 174 амбулаторних карт пацієнтів віком 35–60 років після хірургічного лікування ГП ІІ ступеня тяжкості. Методика закритого кюретажу проведена 100 пацієнтам (1-ша група), відкритого кюретажу – 74 пацієнтам (2-га група). Пацієнтам обох груп проведено терапевтичне лікування ГП, згідно з затвердженими протоколами. Порівняно ефективність закритого і відкритого кюретажу у пацієнтів-носіїв ГВІ.

Punctal dilatation and non-incisional canalicular curettage in the management of infectious canaliculitis

ABSTRACT Objective To describe the outcomes of punctal dilatation and non-incisional canalicular curettage in patients with infectious canaliculitis. Methods A retrospective analysis of 53 canaliculi of 47 eyes of 46 consecutive patients diagnosed with canaliculitis was performed from November 2015 to December 2018. All patients were treated with punctal dilatation and a non-incisional canalicular curettage. Parameters studied include demographics, clinical presentation, microbiological analysis, management and treatment outcomes. The outcome measures were clinical resolution of canaliculitis and resolution of epiphora. Results The mean age at presentation was 59.34 years with female preponderance (M:F = 19:28). Left eye was more affected (64%, n = 30) as compared to the right (36%, n = 17). Only one patient presented bilaterally. Lower canaliculus was most commonly involved (68%, n = 32). Six eyes showed involvement of both upper and lower canaliculus. Presenting symptoms include discharge (81%), swelling of the eyelids (64%), watering (55%), redness (51%) and pain (39%). Punctal dilatation and non-incisional canalicular curettage were performed using punctum dilator and a small chalazion scoop (1 mm Meyhoefer chalazion curette). Of the 53 involved canaliculi, 14 canaliculi of 14 eyes underwent a repeat curettage for complete resolution and 1 canaliculus underwent the same procedure thrice. The most common micro-organisms isolated were Streptococci species (28% cases). At a mean follow-up of 6.8 months, resolution of canaliculitis was achieved in all patients; however, epiphora persisted in two eyes (4%). Conclusion Non-incisional canalicular curettage is a minimally invasive technique with good preservation of the punctal and canalicular anatomy. It also facilitates good anatomical and functional outcomes in infectious canaliculitis.

Preoperative evaluation of residual tumor in patients with endometrial carcinoma by using 18F-FDG PET/CT.

Purpose: To evaluate the value of 18F-FDG positron emission tomography (PET)/computed tomography (CT) for determining the presence of residual tumors after curettage in patients with endometrial cancer.Methods: Preoperative 18F-FDG PET/CT was performed in 90 women with endometrial cancer. PET/CT parameters and clinical characteristics were compared between patients with and without residual tumors. The clinical characteristics of patients with residual tumors that showed low 18F-FDG uptake were also analyzed.Results: Among the 90 patients, 86 had residual tumors. ROC analysis identified a lesion SUVmax value of 5.0 as the optimal cut-off value for predicting whether or not patients had a residual tumor. With the SUVmax cut-off of 5, the sensitivity, specificity, positive predictive value, and negative predictive values for residual tumor prediction were 87.2%, 100%, 100%, and 26.7%, respectively. Univariate analysis showed significant associations between the high PET group (SUVmax > 5) and low PET group (SUVmax ≤ 5), and histologic type (P = 0.043) and tumor size (P < 0.001) in patients with residual tumors. In patients with low-grade and clear cell carcinomas and a tumor size < 1.35 cm, the probability of being in the low-PET group was 47.6%. In such patients, major parts of the residual tumors showed low 18F-FDG uptake, similar to that in patients with no residual tumors.Conclusion: SUVmax was the lone predictive value for the presence of residual tumors after curettage in patients with endometrial cancer. Lesion SUVmax greater than 5 suggested a high possibility of residual tumors. In patients with low-grade and clear cell carcinomas with tumor size < 1.35 cm, residual tumors may present low 18F-FDG uptake, mimicking the metabolic phenotypes of patients without residual tumors.

Diagnostic Values of Pipelle and Standard Curettage Compared to Hysterectomy Pathology in Postmenopausal Bleeding: A Comparative Study.

Background:Postmenopausal bleeding might occur due to many benign and malignant underlying diseases. Differentiating between these diseases poses a great importance. This study was designed to compare the diagnostic value of pipelle endometrial sampling and curettage in patients with postmenopausal bleeding. Further, the results were compared with hysterectomy if performed.Materials and Methods:Eighty-seven patients with postmenopausal bleeding were included. Pipelle sampling endometrial biopsy was performed for patients in office, and then, patients were transferred to the operation room for dilatation and curettage. Pathology results of pipelle sampling were compared with curettage method. If hysterectomy was performed due to any reason, it was compared as well.Results:The pipelle sampling biopsy diagnosed 94.1% of malignant tumors, and curettage sampling biopsy diagnosed 100% of malignant tumors. The sensitivity and specificity of pipelle compared to curettage were 94.12% and 100%, respectively, for the diagnosis of malignant tumors. Based on the Kappa test, the agreement between pipelle and curettage sampling biopsy was statistically significant (P < 0.001).Conclusion:The endometrial sampling with pipelle is safe and cost-effective in patients referred with postmenopausal bleeding. This might avoid the need for general anesthesia for the detection of endometrial hyperplasia and endometrial malignancy.

Accuracy of Karman endometrial aspiration in comparison to conventional D and C in women with AUB at tertiary care hospital in North West Rajasthan.

Background:Approximately 33% of all gynaecological consultations are associated with abnormal vaginal bleeding, and this proportion increases to 70% in the peri and postmenopausal years.Aims and Objective:To compare the diagnostic accuracy of Karman's cannula endometrial aspiration histopathology versus dilatation and curettage in patients with abnormal uterine bleeding.Methodology:In total 100 women of all age groups with a clinical diagnosis of AUB were included in this prospective comparative study. Endometrial aspiration with Karman cannula was performed in the operation theatre prior to curettage to maintain synchronization during sampling.Results:In our study, no significant difference was observed between Karman and D and C regarding sample adequacy (P = 0.07), HPE findings (P = 1) and concordance rate with hysterectomy specimen (P = 1). 95% of the samples obtained by Karman and 98% of those obtained by D and C were adequate. For obtaining an adequate sample by Karman the sensitivity and accuracy was 96.94% and 96% when compared with D and C. Karman and D and C had comparable concordance rates (95% and 95%) with hysterectomy specimen. Karman endometrial sampling is an easy procedure when compared to D and C (P = 0.007). With considering D and C as gold standard Karman endometrial sampling demonstrated 100% accuracy for diagnosing adenocarcinoma, endometrial hyperplasia.Conclusion:Endometrial aspiration with Karman cannula is an easy, safe, cost-effective, accurate, convenient method of achieving histopathological diagnosis. It can be done as an outpatient procedure without analgesia and anaesthesia when compared to D and C which is expensive and invasive method and requires hospitalization and general anaesthesia.

Using 17β-estradiol heparin-poloxamer thermosensitive hydrogel to enhance the endometrial regeneration and functional recovery of intrauterine adhesions in a rat model.

Mechanical damage or infection to the endometrium can lead to the formation of adhesions in the uterine cavity, which may result in reduced reproductive outcome and/or pregnancy complications. The prognosis of this disease is poor due to few effective treatments and the complex environment of endometrium. Heparin-Poloxamer Hydrogel (HP hydrogel) is a nontoxic and biodegradable biomaterial, which has been commonly used as a sustained-release delivery system. In this study, we applied a mini-endometrial curette to scrape the endometrium of rats to mimic the process of curettage in patients. After the establishment of IUA model in rats, we injected the thermo-sensitive hydrogel(E2-HP hydrogel) into the injured uterine cavity and evaluated the therapeutic effect of E2-HP hydrogel on the recovery of IUA. Our results showed that E2-HP hydrogel can significantly facilitate the regeneration of injured endometrium along with inhibiting the cell apoptosis in IUA model. Furthermore, we revealed that E2-HP hydrogel on the recovery of IUA was closely associated with the upregulation of kisspeptin through activating the ERK1/2 and MAPKs p38 pathways. In conclusion, E2-HP hydrogel can effectively transfer E2 into the injured endometrium and it can be considered as a promising therapeutic method for the women with intrauterine adhesions.

Study of Endometrial Aspiration &amp; Sampling versus Conventional Dilation &amp; Curettage in Patients with abnormal uterine Bleeding

Study of Endometrial Aspiration &amp; Sampling versus Conventional Dilation &amp; Curettage in Patients with abnormal uterine Bleeding

Medical versus surgical treatment of first trimester spontaneous abortion: A cost-minimization analysis.

BackgroundTraditionally the gold-standard technique for the treatment of spontaneous abortion has been uterine evacuation by aspiration curettage. However, many studies have proposed medical treatment with misoprostol as an alternative to the conventional surgical treatment. The aim of this study was to apply cost minimization methods to compare the cost and effectiveness of the use of vaginal misoprostol as a medical treatment for first trimester spontaneous abortion with those of evacuation curettage as a surgical treatment.Methodology/Principal findingsWe present a longitudinal, prospective and quasi-experimental research study including a total of 547 patients diagnosed with first-trimester spontaneous abortion, in the period from January 2013 to December 2015. Patients were offered medical treatment with 800 mg vaginal misoprostol or evacuation curettage. Patients treated with misoprostol were followed-up at 7 days and a transvaginal ultrasound was performed to confirm the success of the treatment. If it failed, a second dose of 800 mg of vaginal misoprostol was prescribed and a new control ultrasound was performed. In case of failure of medical treatment after the second dose of misoprostol, evacuation curettage was indicated. The effectiveness of each of the treatment options was calculated using a decision tree. The cost minimization study was carried out by weighting each cost according to the effectiveness of each branch of the treatment. Of the 547 patients who participated in the study, 348 (64%) chose medical treatment and 199 (36%) chose surgical treatment. The overall effectiveness of medical treatment was 81% (283/348) and surgical treatment of 100%. The estimated final cost for medical treatment was € 461.92 compared to € 2038.72 for surgical treatment, which represents an estimated average saving per patient of € 1576.8.Conclusions/SignificanceMedical treatment with misoprostol is a cheaper alternative to surgery: in the Spanish Public Healthcare System, it is five times more inexpensive than curettage. Given its success rates higher than 80%, mild side effects, controllable with additional medication and the high degree of overall satisfaction, it should be prioritized over the evacuation curettage in patients who meet the treatment criteria.

Clinical analysis of uterine artery embolization combined with double balloon catheter plus curettage for patients with placenta previa who underwent pregnancy termination and suffered antenatal massive hemorrhage in the 2nd trimester

Rationale:It is very difficult to treat patients with placenta previa who underwent pregnancy termination and suffered antenatal massive hemorrhage in the 2nd trimester.Patient concerns:In this study, case 1 was with fetal malformation of 18-trisomy syndrome at gestation of 19 weeks + 2 days, case 2 was with fetal malformation of 18-trisomy syndrome at gestation of 22 weeks + 1 day, and case 3 was for intrauterine fetal death at gestation of 27 weeks. All the 3 cases were completely placenta previa.Diagnoses:For the 3 patients, completely placenta previa was confirmed by ultrasound examination after hospitalization and underwent pregnancy termination for fetal death or fetal malformation in the 2nd trimester.Interventions:The 3 patients with placenta previa underwent pregnancy termination by mifepristone combined with ethacridine lactate in the 2nd trimester for intrauterine fetal death or fetal malformation from June 2017 to May 2018, and suffered antenatal massive hemorrhage during termination. Uterine artery embolization (UAE) was immediately performed to achieve hemostasis, then double balloon catheter (DBC) was carried out to promote cervical ripen, at last curettage was implemented with the help of ultrasound. After all these procedures, the clinical outcomes were observed.Outcomes:The antenatal bleeding volume of these 3 patients were about 500, 600, and 550 mL. After implementing the combined treatment, all patients completed the abortion. The UAE-DBC time interval and DBC-curettage time interval were 58.4 and 6.0 hours, respectively, for case 1, whereas almost 0 (i.e., immediately) for cases 2 and 3. Case 1 had a fever lasting for 3 days, and the maximum body temperature was up to 39°C after UAE. Moreover, the blood culture was positive for Escherichia coli after curettage in case 1, whereas it was negative in the other 2 cases.Lessons:The UAE-DBC–curettage combined treatment is safe and effective for patients with placenta previa who undergo pregnancy termination and suffered massive antenatal hemorrhage in the 2nd trimester. Future studies are needed to advance our observation.

A comparison of intralesional triamcinolone acetonide injection and incision-curettage for chalazion treatment

Objective: To compare the efficacy of intralesional triamcinolone acetonide with surgical incision and curettage in patients with chalazion. Material and Method: This longitudinal interventional study was carried out during 1st September 2015 to 31st August 2016 at Kamlesh Netralaya Hospital at Ambikapur, Chhattisgarh in central India. Total 60 patients with Chalazion of (≥2mm in size) were randomly divided into two groups of 30 patients each. The first group of patients (N=30) was treated by 0.1 to 0.2 mL intralesional triamcinolone acetonide injection (40 mg/mL) and the second group of patients (N=30) were treated surgically by incision-curettage. Post steroid injection, the reduction in chalazion size was measured at 2 weeks and at 4 weeks. Results: Out of 60 patients, 58.33% were females with mean age of 31.8 ± 9.1 years. There were total 79 chalazion in two groups. Among those treated using intralesional triamcinolone acetonide (ILTA), 29 (70.73%) chalazion resolved at 2 week. The unresolved chalazion were repeated the ILTA injection at 2nd week and followed till 4 week. The mean 11-point numerical rating scale (NRS) score for pain intensity was significantly lower in ILTA group as compared to IC group (2.3± 0.42 vs 6.7 ± 1.2, P-value = 0.001). Conclusion: The results of intralesional triamcinolone acetonide injection treatment are comparable to that of surgical incision and curettage (IC) after second injection. Patients experienced less pain and were more satisfied with the intralesional triamcinolone acetonide injection.

New Crosslinked Hyaluronan Gel for the Prevention of Intrauterine Adhesions after Dilation and Curettage in Patients with Delayed Miscarriage: A Prospective, Multicenter, Randomized, Controlled Trial

Study ObjectivesTo evaluate the efficacy of a new crosslinked hyaluronan (NCH) gel in reducing the formation of intrauterine adhesions (IUAs) after dilation and curettage (D&C). DesignRandomized controlled trial (Canadian Task Force classification I). SettingsSix hospitals for maternal and child healthcare in China. PatientsA total of 300 patients were randomized to undergo D&C for delayed miscarriage without previous history of D&C. Twenty-six patients (9%) were lost to follow-up and were excluded from the analysis. InterventionsWomen were randomly assigned to D&C alone (control group; n = 150) or D&C plus NCH gel application (NCH gel group; n = 150) with 1:1 allocation. Measurements and Main ResultsAll patients were evaluated using the American Fertility Society classification of IUAs during follow-up diagnostic hysteroscopy, scheduled at 3 months after D&C procedure. The primary endpoint was the number of women with IUAs at 3 months, and the secondary endpoints were adhesion scores and severity of IUAs. Postoperative efficacy data were available for 274 women (137 in each group). Intrauterine adhesion formations were observed in 13 of the 137 women (9.5%) in the NCH gel group and in 33 of the 137 women (24.1%) in the control group (p = .0012; relative risk [RR], 0.3939; 95% confidence interval [CI], 0.2107–0.7153), a difference of 14.6% (95% CI, 5.92%–23.28%) between the 2 groups. The extent of intrauterine cavity involved, type of adhesion and menstrual pattern, and cumulative adhesion scores were significantly lower in the NCH gel group compared with the control group (p = .0007, .008, .0012, and .0006, respectively). The proportion of women with moderate to severe IUAs was significantly lower in the NCH gel group than that in the control group (1 of 137 [0.7%] vs 16 of 137 [11.7%]; p = .0002; RR, 0.0625; 95% CI, 0.0084–0.4648), a difference of 11.95% (95% CI, 5.39%–16.51%) between the 2 groups. ConclusionsThe current study demonstrates that IUAs are frequently formed after D&C for delayed miscarriage in women without a previous history of D&C procedures, and the application of NCH gel significantly reduces IUA formation.

Wide resection versus curettage in giant cell tumor with pathological fracture? A systematic review and meta-analysis

IntroductionCurrently there is no consensus if wide resection and curettage in giant cell tumor have effect on local recurrence rate in the presence of a pathological fracture. Material and methodWe conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients of giant cell tumor with and without a pathological fracture. The odds ratio (OR) of local recurrence between wide resection and curettage group in giant cell tumor with pathological fracture was calculated. Results05 eligible papers were selected for final analysis. This included patients, of whom (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients of pathological fracture treated with wide resection and curettage was 0.298% (95% Confidence interval (CI) 0.0669–1.329, p=0.97). ConclusionWide resection and curettage in patients of giant cell tumor with pathological fracture has difference in local recurrence rates. However the presence of a pathological fracture should no be only influential factor in the decision making to perform wide resection or curettage. A proper planning and judicious approach is required in giant cell tumor with pathological fracture for deciding the appropriate treatment method.

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases.

The purpose of this retrospective study was to evaluate the safety and efficacy of uterine artery embolization (UAE) followed by curettage for conservative management of cervical pregnancy. Retrospective review. Peking University First Hospital. Patients with cervical pregnancy diagnosed by trans-vaginal ultrasound at Peking University First Hospital between January 2003 and December 2014. We retrospectively reviewed the clinical background and outcomes of patients with cervical pregnancy who underwent UAE followed by curettage for prevention of massive vaginal bleeding and removal of gestational tissue from the cervix. We also reviewed the literature on the role of UAE in the treatment of cervical pregnancy. Clinical assessments included gestational age, gravidity, endocervical canal mass, serum beta-human chorionic gonadotrophin (β-HCG) level, blood loss, hospitalisation stay and expenses, time of resumption of menstruation and subsequent pregnancy outcomes. A total of 19 patients with cervical pregnancy treated with UAE followed by curettage were identified. Curettage was performed 24-72hours after UAE in 16 patients, within 24hours after UAE in three patients. None of the patients underwent a hysterectomy as a result of cervical pregnancy. Of the nine patients with available follow-up information (median follow-up time 59months), eight resumed normal menstruation and one had a term pregnancy with a normal vaginal delivery. Quick regression of serum β-HCG level, low blood loss and short hospital stay were observed. UAE combined with curettage is a safe, effective and fertility-sparing choice for treatment of patients with cervical pregnancy. A serial of 19 patients with cervical pregnancy treated with UAE followed by curettage showed a good prognosis.

Indications for prophylactic osteosynthesis associated with curettage in benign and low-grade malignant primitive bone tumors of the distal femur in adult patients: a case series.

BackgroundThe aim of the study was to evaluate whether the use of preventive osteosynthesis after curettage in benign and primitive low-grade malignant bone tumor localized in the distal femur in adult patients provides sufficient mechanical stability to the system as to allow weight-bearing and reduce the risk of postoperative fracture. Additionally, lower limb function after curettage and preventive osteosynthesis was evaluated.Materials and methodsWe analyzed twelve cases of benign and low-grade malignant bone lesions of the distal femur in adult patients treated in our orthopedic department between 2008 and 2011 with curettage, bone filling and preventive osteosynthesis. All patients were treated with curettage with the use of high-speed cutters, plus liquid nitrogen as local adjuvant in low-grade malignant lesions, and filling of the lesion with bone graft or allograft or acrylic cement, followed by osteosynthesis.ResultsNo fractures or major complications were observed; good function of the knee was observed.ConclusionWe recommend preventive osteosynthesis after curettage in patients with very large lesions (>5 cm, >60 cm3) or high functional requirements, in obese patients, and when local adjuvants are used.Level of evidenceLevel IV retrospective case-series study.

The impact of uterine curettage postpartum on maternal sFlt-1 concentration.

Our purpose was to investigate the influence of a uterine curettage on the immediate maternal sFlt-1 concentration post partum. Forty-six patients booked for delivery via primary caesarean section were included in a prospective open, case control study. Eighteen of them achieved an intraoperative curettage and formed the treatment group, 28 patients without curettage were enrolled in the control group. Maternal sFlt-1 serum values were measured immediately before and 24 h after delivery. Patients who underwent a uterine curettage showed a relative decrease of 70% (median 3670±1110 pg/mL-1143±270 pg/mL) in comparison to the control group with 65% (median 3132±636 pg/mL-1098±611 pg/mL; P=0.558). Additionally, three patients with preeclampsia and curettage were included, who showed a relative decrease of 76%. A uterine curettage may slightly accelerate the fall of the postpartal sFlt-1 concentration. The previously described benefit of curettage in patients with preeclampsia regarding faster recovery or treatment of postpartum seizures may be partly explained as mediated by anti-angiogenic factors.

Comparison of diagnostic accuracy between endometrial curettage and pipelle aspiration biopsy in patients treated with progestin for endometrial hyperplasia: a Korean Gynecologic Oncology Group Study (KGOG 2019).

A prospective multicenter trial has been started in Korea to evaluate the diagnostic accuracy of endometrial aspiration biopsy compared with dilatation and curettage in patients treated with progestin for endometrial hyperplasia. For conservative treatment of endometrial hyperplasia, orally administered progestins are most commonly used method with various treatment regimens and more recently, the levonorgestrel-releasing intrauterine system also has been used successfully to treat endometrial hyperplasia. However, there is no report about the accuracy of endometrial sampling during hormonal treatment for follow-up evaluation of endometrial hyperplasia. Patients with histologically confirmed endometrial hyperplasia are offered hormonal treatment with any one of the following three options: oral medroxyprogesterone acetate 10 mg/day for 14 days per cycle, continuous oral medroxyprogesterone acetate 10 mg/day or insertion of levonorgestrel-releasing intrauterine system. Histological surveillance is performed at 3 months or 6 months following initial treatment. Endometrial tissues are obtained via endometrial aspiration biopsy using a pipelle and dilatation and curettage. In the case of levonorgestrel-releasing intrauterine system, endometrial aspiration biopsy will be done with levonorgestrel-releasing intrauterine system in uterus and then, after the removal of levonorgestrel-releasing intrauterine system, dilatation and curettage will be done. The biopsy findings will be compared. The primary endpoint is to compare the pathological outcome of endometrial aspiration with dilatation and curettage. The secondary endpoint is the response rate with three types of progestin treatment at 6 months.

Uterine artery Doppler in the management of early pregnancy loss: a prospective, longitudinal study.

BackgroundThe pharmacological management of early pregnancy loss reduced substantially the need for dilation and curettage. However, prognostic markers of successful outcome were not established. Thus the major purpose of this study was to determine the sensitivity and specificity of the uterine artery pulsatility (PI) and resistance (RI) indices to detect early pregnancy loss patients requiring dilation and curettage after unsuccessful management.MethodsA cohort prospective observational study was undertaken to include women with early pregnancy loss, ≤ 12 weeks of gestation, managed with mifepristone (200 mg) and misoprostol (1600 μg) followed by PI and RI evaluation of both uterine arteries 2 weeks after. At this time, in 173/315 patients, incomplete miscarriage was diagnosed. Among them, 32 underwent uterine dilatation and curettage at 8 weeks of follow-up.ResultsThe cut-off points for the uterine artery PI and RI, leading to the maximum values of sensitivity (69.5%, CI95%: 61.5%-76.5% and 75.0%, CI95%: 57.9%-86.8%, respectively) and specificity (75.0%, CI95%: 57.9%-86.8% and 65.6%, CI95%: 48.3%-79.6%, respectively), for the discrimination between the women who needed curettage from those who resolved spontaneously were 2.8 and 1, respectively.ConclusionsThe potential usefulness of uterine artery Doppler evaluation to predict the need for uterine curettage in patients submitted to medical treatment for early pregnancy loss was demonstrated.

Pipelle endometrial sampling versus conventional dilatation &amp; curettage in patients with abnormal uterine bleeding

This study was designed to compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; where endometrial sampling was carried out before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the dilatation & curettage sample and the dilatation & curettage reports were considered as the gold standard. 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by the Pipelle device were adequate for histopathological examination. The histolopathological examination of 140 samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium. Also, it had 88.9% sensitivity, and 99.2% negative predictive value (NPV) and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. The endometrial sampling using Pipelle is a safe, accurate, cost effective outpatient procedure, which avoids general anesthesia and has a high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.

Pipelle endometrial sampling versus conventional dilatation &amp; curettage in patients with abnormal uterine bleeding

To compare the diagnostic accuracy of Pipelle endometrial sampling with conventional dilatation & curettage in patients with abnormal uterine bleeding. One hundred and forty patients with abnormal uterine bleeding were included in this comparative study; endometrial sampling was done before cervical dilatation by Pipelle device followed by conventional dilatation & curettage (D&C). The histopathology report of the Pipelle sample was compared with that of the D&C sample and the D&C report was considered as the gold standard. 100% of the samples obtained by conventional D&C, while 97.9% of the samples obtained by Pipelle device were adequate for histopathological examination. The histolopathological examination of one hundred and forty (140) samples obtained by conventional D&C revealed proliferative endometrium in 37 specimens, secretory endometrium in 33 specimens, endometrial hyperplasia in 49 specimens (45 without atypia & 4 with atypia), endometritis in 8 specimens, endometrial polyps in 3 specimens and malignant endometrium in 10 specimens. In this study; the Pipelle device had 100% sensitivity, 100% specificity and 100% accuracy for diagnosing endometrial hyperplasia, endometrial carcinoma, proliferative and secretory endometrium, also, it had 88.9% sensitivity, 99.2% NPV and 99.3% accuracy for diagnosing endometritis and it had 60% sensitivity, 89.6% NPV and 98.6% accuracy for diagnosing endometrial polyps. The endometrial sampling using Pipelle is safe, accurate, cost effective outpatient procedure, avoids general anesthesia with high sensitivity and specificity for detection of endometrial hyperplasia and endometrial malignancy.

Transcervical Embryoscopy: Images of First-Trimester Missed Abortion

Transcervical embryoscopy is a hysteroscopy performed before obstetric curettage in cases of first-trimester missed abortion. It allows clear visualization of the demised embryo ‘‘in uterus,’’ adding useful information for the diagnosis of the cause of pregnancy failure [1]. The procedure is performed with the patient under general anesthesia and in the dorsolithotomy position, before obstetric curettage in patients with ultrasonographic diagnosis of fetal demise during the first trimester of pregnancy [2]. With a 5-mm 30-degree angle rigid hysteroscope and 0.9% normal saline solution, with pressures between 50 to 100 mm Hg, the vagina, cervical canal, uterus, tubal ostium, parietal decidua, and chorion are visualized. The opening of