Green urine sign after laparoscopic chromopertubation as an effect of severe contrast intravasation: a report of three cases

Tubal diseases are responsible for 25% to 35% of female infertility. Laparoscopic chromopertubation is the gold standard for assessing tubal patency when female infertility is suspected. Intravasation is a complication of intrauterine procedures involving the passage of fluid filling the uterine cavity into the bloodstream through endometrial vessels (from the myometrial veins to the uterine venous plexuses). This complication has been described during hysterosalpingography and sonohysterosalpingography. We herein present a report of three cases in which severe intravasation occurred during laparoscopic chromopertubation using methylene blue as a contrast agent. The intravasation manifested as green urine (i.e., the “green urine sign”). The presence of methylene blue in the urine and blood was confirmed by laboratory tests. All three patients had risk factors for intravasation as described in the literature (unilateral or bilateral tubal obstruction, endometriosis, and previous intrauterine procedures for Mullerian duct anomalies and Asherman’s syndrome). The green urine sign appeared a few hours after laparoscopic chromopertubation and spontaneously resolved after 24 hours. Cystoscopy was performed to rule out bladder injury. All three patients required only clinical observation.

Download Full-text

Accuracy of a new hysteroscopic method in the assessment of tubal patency: Hysteroscopic Chromotubation

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2017.692 ◽

2018 ◽

Vol 24 (2) ◽

pp. 82

Author(s):

Burak Yucel ◽

Emine Demirel ◽

Sefa Kelekci ◽

Kerem Doga Seckin ◽

Osama Shawki

Keyword(s):

Methylene Blue ◽

Cohort Study ◽

Gold Standard ◽

Uterine Cavity ◽

High Sensitivity ◽

Office Hysteroscopy ◽

Predictive Values ◽

Tubal Patency ◽

Infertile Women ◽

Sensitivity Specificity

ObjectiveThe aim of this study was to evaluate the diagnostic accuracy of hysteroscopic chromopertubation (HCT) in the assessment of tubal patency by comparing its results with laparoscopic chromopertubation (LCT).Study DesignThe population of this prospective cohort study consisted of both fertile and infertile women. Sixty-four women were included to the study. HCT was assessed by the observation of the transport of highly concentrated methylene blue from uterine cavity to tubal ostia. The results of HCT were compared with the results of LCT as a gold standard. The accuracy of HCT, sensitivity, specificity, positive and negative predictive values in diagnosing tubal patency were calculated.ResultsThe results of HCT and LCT were evaluated for right and left tubes, separately. One hundred and twenty-eight tubes were determined. Sensitivity, specificity, positive and negative predictive values for HCT were; 85.85%, 59.09%, 91% and 46.43%, respectively.Conclusion This study’s result showed that HCT had high sensitivity and moderate specificity values in the assessment of tubal patency. HCT during office hysteroscopy could give the chance to practitioners to assess tubal patency without subjecting the patient to multiple procedures.

Download Full-text

The assessment of endometrial pathology and tubal patency of infertile patients: MR-HSG and X-ray HSG

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175432 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5135

Author(s):

Arzu Turan ◽

Halil Aslan ◽

Nese Colcimen ◽

Fatma Beyazal Celiker ◽

Meryem Demirtas

Keyword(s):

Fallopian Tube ◽

Saline Solution ◽

Uterine Cavity ◽

Female Infertility ◽

Endocrine Disorders ◽

X Ray ◽

Tubal Patency ◽

New Methods ◽

Contrast Enhanced ◽

Infertile Patients

Background: Infertility is an important disorder for the pairs. Genetic, endocrine disorders or structural genital abnormalities can be cause. The cause of infertility can be determined with careful.Methods: Although it can be reported that ultrasound with saline solution or contrast enhanced hystero salpingo-sonography is the best method to evaluate the uterine cavity and Fallopian tube patency, conventional hysterosalpingography (X-ray-HSG) remains the most commonly used procedure for imaging the uterine cavity and the fallopian tube patency in the evaluation of female infertility. But ionizing radiation to genital organs is the most important problem for X-ray-HSG.Results: For this reason, they are still working on new methods to investigate female infertility as an alternative to X-ray HSGMRI is a favorite method because of excellent image characterization for the female genitals.Conclusions: In this study, the diagnostic performance of MR-HSG was compared with X-ray-HSG which was accepted as a gold standard for detection of tubal patency and pathology of the endometrial cavity.

Download Full-text

EVALUATION OF HYSTEROSALPINGOGRAPHY VERSUS LAPAROSCOPY IN THE DETERMINATION OF TUBAL FACTORS IN FEMALE INFERTILITY: A HOSPITAL BASED COMPARATIVE STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i9.1421 ◽

2020 ◽

Vol 4 (9) ◽

Author(s):

Richa Choudhary ◽

Rishikant Sinha

Keyword(s):

Female Infertility ◽

Diagnostic Methods ◽

Panoramic View ◽

Tubal Patency ◽

Pelvic Organs ◽

Clinical Investigations ◽

Detailed Assessment ◽

Reproductive Anatomy ◽

Tubal Pathology

Objectives: Hysterosalpingography and laparoscopy both are the diagnostic methods for assessment of female infertility. The present study was to compare the evaluation of hysterosalpingography (HSG) versus laparoscopy in determination of tubal factors in female infertility. Methods: Detailed assessment, physical examination and clinical investigations were performed in all 100 infertile female with age 20 years to 40 years. All patients were advised to perform digital HSG. Patients with an abnormal HSG underwent laparoscopy without delay, whereas in patients with a normal HSG, laparoscopy was performed three months after HSG. HSG is best scheduled during the 2nd -5th day interval immediately following the end of menstruation, to minimize risk for infection, avoid interference from intrauterine blood and clot, and to prevent any possibility that the procedure might be performed after conception. Results: Data was analysed by using IBM SPSS version 23 software. All data was tabulated and percentages were calculated. Mean ± standard deviation was observed. Conclusions: Diagnostic laparoscopy is the gold standard in diagnosing tubal pathology and other intra-abdominal causes of infertility. Other hand, Hysterosalpingography is a frequently utilized diagnostic tool in the assessment of tubal status and detection of uterine anatomical defects in infertility. Hysterosalpingography and laparoscopy are not alternatives but complimentary investigations. But, inadequacy of hysterosalpingography (HSG) in determining the state of tubal patency, emphasizes the need for laparoscopy. Laparoscopy provides both a panoramic view of the pelvic reproductive anatomy and a magnified view of pelvic organs and peritoneal surfaces. Keywords: Female infertility, Tubal patency, HSG, Laparoscopy

Download Full-text

Effects of methylene blue, indigo carmine solution and autologous erythrocyte suspension on formation of adhesions after injection into rats

Reproduction ◽

10.1530/reprod/120.2.225 ◽

2000 ◽

pp. 225-229 ◽

Cited By ~ 5

Author(s):

A Gul ◽

C Kotan ◽

I Dilek ◽

T Gul ◽

A Tas ◽

...

Keyword(s):

Methylene Blue ◽

Macrophage Activation ◽

Indigo Carmine ◽

Adhesion Formation ◽

Albino Rats ◽

Erythrocyte Suspension ◽

Peritoneal Adhesions ◽

Tubal Patency ◽

Macrophage Activity ◽

Group Score

The aim of this study was to determine whether autologous erythrocyte suspension can be used as a dye for evaluation of tubal patency and whether it has any advantages over methylene blue or indigo carmine solutions. Reproductively healthy female nulliparous Wistar Albino rats (n = 30), aged 6 months, mass 165-195 g, were assigned randomly to three groups. Rats received a 1 ml i.p. injection of 5% (w/v) methylene blue solution (methylene blue group: n = 10), 5% (w/v) indigo carmine solution (indigo carmine group: n = 10) or 5% (v/v) fresh autologous erythrocyte suspension (autologous erythrocyte group: n = 10). At 4 weeks after injection, a small sterile opening was made in the peritoneal cavity of each rat. The cavity was rinsed once with TCM-199 to collect macrophages. The rinsed peritoneal contents were cultured overnight to evaluate macrophage activation. The peritoneal opening was expanded for evaluation of adhesion formation. Only one rat from the autologous erythrocyte group had intra-peritoneal adhesions (score 2), whereas all rats in the methylene blue group (score 1: n = 1; score 2: n = 4; score 3: n = 4; and score 4: n = 1) and seven rats in the indigo carmine group (score 1: n = 1; score 2: n = 2; score 3: n = 3; and score 4: n = 1) had intra-abdominal adhesions. Macrophage activity was observed in the cultured peritoneal contents collected from the methylene blue and indigo carmine groups but not from the autologous erythrocyte group. Adhesion formation could be due to macrophage activation caused by methylene blue and indigo carmine solutions. These results indicate that tubal patency can be observed by laparoscopy using autologous erythrocyte suspension. The results of this study are believed to be the first to indicate that a patient's own erythrocyte suspension could be used during observation of tubal patency by laparoscopy. However, further studies are required.

Download Full-text

Endometrial Regeneration in Asherman's Syndrome: Clinical and Translational evidence of Stem Cell Therapies

Current Stem Cell Research & Therapy ◽

10.2174/1574888x14666190213100528 ◽

2019 ◽

Vol 14 (6) ◽

pp. 454-459

Author(s):

Xuejing Hou ◽

Ying Liu ◽

Isabelle Streuli ◽

Patrick Dällenbach ◽

Jean Dubuisson ◽

...

Keyword(s):

Stem Cell ◽

Molecular Mechanisms ◽

Uterine Cavity ◽

Stem Cell Therapies ◽

Intrauterine Adhesions ◽

Asherman’S Syndrome ◽

Cell Therapies ◽

Fibrotic Process ◽

Physical Barriers

Asherman’s Syndrome or Intrauterine adhesions is an acquired uterine condition where fibrous scarring forms within the uterine cavity, resulting in reduced menstrual flow, pelvic pain and infertility. Until recently, the molecular mechanisms leading to the formation of fibrosis were poorly understood, and the treatment of Asherman’s syndrome has largely focused on hysteroscopic resection of adhesions, hormonal therapy, and physical barriers. Numerous studies have begun exploring the molecular mechanisms behind the fibrotic process underlying Asherman’s Syndrome as well as the role of stem cells in the regeneration of the endometrium as a treatment modality. The present review offers a summary of available stem cell-based regeneration studies, as well as highlighting current gaps in research.

Download Full-text

Abstract 16517: Atrial Natriuretic Peptide as a Marker for Early Rule-Out of Acute Myocardial Infarction

Circulation ◽

10.1161/circ.130.suppl_2.16517 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Anna Slagman ◽

Julia Searle ◽

Fabian Holert ◽

Jörn Ole Vollert ◽

Reinhold Muller ◽

...

Keyword(s):

Emergency Department ◽

Gold Standard ◽

Cardiac Troponin ◽

Roc Analysis ◽

Troponin I ◽

Limit Of Detection ◽

Normal Population ◽

Area Under The Curve ◽

Chief Complaints ◽

Rule Out

Introduction: Mid-regional pro-ANP is mainly synthesized in the atria of the heart and it′s secretion is stimulated by ischemia and distension of the myocardium. Objective: To assess the utility of ANP for rule out NSTEMI in combination with cardiac troponin in unselected patients who attend the Emergency Department (ED) with acute cardiac chief complaints. Methods: Patients with chest pain and dyspnea were enrolled over a period of 30 months in the Emergency Department (n=537). Patients with STEMI were excluded from the analysis as diagnosis is ECG- and not biomarker-based (n=18). Blood samples were drawn within 2 hours after admission. Gold-Standard diagnoses were adjudicated by an independent cardiologist. ANP was measured using the BRAHMS Kryptor MR-proANP assay. The lower limit of detection is 2.1 pmol/l. The 97.5 th percentile of a normal population is 86.2 pmol/l and was applied as a cut-off value in this analysis. Troponin I was measured using the Stratus CS and a cut-off value of 0.1 μg/L was applied. Variables are shown as median (IQR) and 95%-CIs. Results: The median ANP-value in all patients (n=519) was 135 pmol/l. Patients with NSTEMI (n=58) had significantly higher ANP-values (244/104-350 pmol/l) as compared to patients with other diagnoses (126/74-256; p<0.0001). In ROC-analysis ANP had an area under the curve of 0.648 (CI:0.582-0.715) for the diagnosis of NSTEMI. Of all patients, 74.2% were troponin negative at admission (n=385). Of these patients, 32.2% (n=124) were also ANP negative. The prevalence of AMI in this subgroup was 1.6% (n=2). The NPV for the combination of troponin and ANP was 98.4% (CI: 94.3-99.8%) and thus higher than for both markers alone (figure 1). In combination with Copeptin, the NPV increased to 100% (CI: 96.3-100%). Conclusions: ANP has potential for early rule-out of AMI in combination with troponin and, due to a different pathophysiological stimulus, it might be used as part of a triple-marker strategy with copeptin and troponin.

Download Full-text

Use of free microvascular flaps in the management of the head and neck defects

Vojnosanitetski pregled ◽

10.2298/vsp0608713n ◽

2006 ◽

Vol 63 (8) ◽

pp. 713-720 ◽

Cited By ~ 2

Author(s):

Zivorad Nikolic ◽

Jelena Jeremic ◽

Radoje Milosavljevic

Keyword(s):

Head And Neck ◽

Gold Standard ◽

Clinical Observation ◽

Clinical Results ◽

Test Results ◽

Flap Necrosis ◽

Free Flap Reconstruction ◽

Microsurgical Reconstruction ◽

Flap Viability ◽

Patient Series

Background/aim: In the field of contemporary head and neck reconstructive surgery, free vascularized tissue transfer is becoming a gold standard. The aim of this study was to review our clinical results and experience, with use of free microvascular flaps and compare them with the recently published patient series. Methods. During the period from 2001 to 2005, 37 patients underwent microsurgical reconstruction after the tumor ablation in the region of head and neck. Flap viability was monitored intraoperatively with the Ackland test and postoperatively by the clinical observation and mini-Doppler test. Results. The overall success rate was 83.8%. The complications that appeared were: one complete flap necrosis due to venous thrombosis, and five late flap ischemic necroses, in the period from the 10th to 14th postoperative day. Conclusion. Free flap reconstruction of the head and neck is a surgical technique that provides the reconstruction of complex and extensive defects, that could not be performed by using local or regional flaps.

Download Full-text

Polyarthritis associated with COVID-19 (clinical case)

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-5-76-79 ◽

2021 ◽

Vol 15 (5) ◽

pp. 76-79

Author(s):

E. S. Aronova ◽

B. S. Belov

Keyword(s):

Clinical Data ◽

Laboratory Tests ◽

Clinical Case ◽

Clinical Observation ◽

Laboratory Data ◽

Careful Study ◽

Instrumental Methods

The article describes the clinical observation of the onset of polyarthritis after COVID-19. Clinical data, laboratory tests' and instrumental methods results in dynamics, as well as approaches to therapy are presented. The discussion reflects modern views on the causes of the development of articular syndrome after SARS-CoV-2, with special attention to the need for a careful study of the history, clinical and laboratory data of patients with COVID-19.

Download Full-text

Endometrial Infertility in Patients of Late Reproductive age (a review)

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2020-27-6-149-163 ◽

2020 ◽

Vol 27 (6) ◽

pp. 149-163

Author(s):

K. V. Uryupina ◽

I. I. Kutsenko ◽

E. I. Kravtsova ◽

J. V. Kudlai ◽

I. I. Kravtsov

Keyword(s):

Assisted Reproduction ◽

Endometrial Thickness ◽

Uterine Cavity ◽

Endometrial Receptivity ◽

Female Infertility ◽

Reproductive Age ◽

Local Immunity ◽

Age Related ◽

Choice Of Treatment ◽

Uterine Infertility

Background. Endometrial infertility is a frequent cause of failure in assisted reproduction. Causes of endometrial infertility are manifold and require comprehensive assessment for a successful choice of treatment strategy.Objectives. A review of infertility concepts accounting for endometrial infertility in women of late reproductive age.Methods. Bibliographic analysis: sources for review were mined in the PubMed, MedLine, eLibrary and Cyberleninka databases at a depth of 10 years. Keyword queries were: endometrial factors of infertility, uterine infertility [маточные факторы бесплодия], causes of infertility. Selected articles related to female infertility and, particularly, endometrial factors of infertility. Low-informative articles were not considered.Results. A total of 51 sources were analysed, with 36 selected in the review. The reviewed evidence suggests that endometrial female infertility in late reproductive age is associated with cumulative gynaecological pathology and age-related change adversely impacting endometrial receptivity and synchrony with embryo maturation in assisted reproductive protocols.Conclusion. Determining the functional status of endometrium is prerequisite for the outcome prognosis in assisted reproduction due to feasible failures to conceive with a vital embryo but reduced endometrial receptivity. This observation warrants a timely diagnosis and treatment of endometrial disorders prior to having assisted reproductive interventions. Woman’s age is the main predictor of successful pregnancy in IVF/ICSI protocols. Among the main markers of successful implantation is endometrial thickness. Uterine infertility may relate to impaired local immunity and autoimmune responses in uterine cavity. The most common mechanisms of uterine infertility are associated uterine myoma, endometriosis and endometritis. Women with uterine infertility attempting IVF/ICSI procedures often exhibit asynchronous endometrial development relative to the embryo maturity for implantation.

Download Full-text

Detecting diagnostic error in psychiatry

Diagnosis ◽

10.1515/dx-2013-0032 ◽

2014 ◽

Vol 1 (1) ◽

pp. 75-78 ◽

Cited By ~ 3

Author(s):

James Phillips

Keyword(s):

Error Detection ◽

Gold Standard ◽

Laboratory Tests ◽

General Medicine ◽

Diagnostic Error ◽

Diagnostic Process ◽

Psychiatric Diagnoses ◽

Tissue Analysis ◽

Laboratory Findings ◽

Diagnostic Categories

AbstractThe question of diagnostic error in psychiatry involves two intertwined issues, diagnosis and error detection. You cannot detect diagnostic error unless you have a reliable, valid method of making diagnoses. Since the diagnostic process is less certain in psychiatry than in general medicine, that will make the detection of error less confidant. Psychiatric diagnostic categories are developed without laboratory tests and other biomarkers. These limitations dramatically weaken the validity of psychiatric diagnoses and render error detection an uncertain undertaking, with go gold standard such as laboratory findings and tissue analysis, as in most of general medicine. With these limitations in mind, I review the methods that are available for error detection in psychiatry.

Download Full-text