Differences between proximal and distal endometrial monolayer thickness in women aged over 50 years undergoing saline infusion sonohysterography

Background Saline infusion sonohysterography (SIS) is a procedure performed to evaluate the endometrium in women with postmenopausal bleeding. Purpose To investigate differences in endometrial monolayer measurements in women aged >50 years undergoing SIS. Material and Methods Retrospective study of women aged >50 undergoing SIS. Endometrial echo (EE) was measured according to the International Endometrial Tumor Analysis (IETA) guidelines. Monolayer thickness was compared between anterior and posterior uterine walls and between the monolayer that was proximal or distal to the ultrasound probe. Presence and location of focal thickening and polyps on each of the monolayers were assessed. Results SIS was performed in 608 patients. Of them, 485 (79.8%) had anteverted, 85 (14%) retroverted, and 38 (6.2%) a midposition uterus. The mean posterior monolayer was thicker than the anterior monolayer (2.14 mm vs. 1.88 mm; P = 0.002). The distal monolayer was thicker than the proximal layer in both anteverted and retroverted uteri (2.18 mm vs. 1.84 mm; P < 0.0001). In 16% of women, the difference between distal and proximal monolayers was ≥1 mm. Focal thickening was seen 3.3 times more frequently in the distal endometrium. Among women with a double layer EE >4 mm, 18.8% had a proximal layer of <2 mm while only 4.6% had a distal EE <2 mm. Conclusion Distal endometrium measures thicker than the proximal endometrium in most SIS cases and in one out of six women, the difference is >1 mm. The distal layer is three times more likely to contain focal thickening. Sonologists should be conscious of possible enhancement artifact when measuring the EE during SIS.

Indication of Treatment For Children And Adolescents With Postural Tachycardia Syndrome By Intravenous Saline Infusion

Background: Intravenous saline infusion is considered effective for the treatment of postural tachycardia syndrome (POTS) in adults. However, few studies have assessed the efficacy of intravenous saline infusion for POTS in children and adolescents. Aim: This study aimed to evaluate the efficacy of intravenous saline infusion in children and adolescents with POTS.Methods: A total of 107 children with POTS (median age: 13 years, range: 10–15 years) were enrolled. Eighty-eight children were in the intravenous saline infusion group and 19 children were in the comparison group. Blood pressure (BP) and pulse rate (PR) were recorded before and after standing. A standing test was performed early in the morning for 2 consecutive days. A volume of 1.5 L of saline was administered intravenously to each participant in the intervention group for a mean duration of 17 hours between the two standing tests.Results: The mean change in PR was significantly lower in the intervention group than in the comparison group during the second test (36.9 vs. 52.8 beats/minute, p<0.001). Additionally, the mean change in PR was significantly lower in the second test than in the first test (44.7 beats/minute) in the intervention group (p<0.001). However, the mean change in systolic BP was not different before and after intravenous saline infusion between the two groups or between the two tests in each group.Conclusion: Intravenous saline infusion reduces the increased PR on standing in children with POTS. Intravenous saline infusion improves tachycardia in children with POTS when standing.

The saline infusion test for primary aldosteronism: implications of immunoassay inaccuracy

Context Diagnosis of primary aldosteronism (PA) for many patients depends on positive results for the saline infusion test (SIT). Plasma aldosterone is often measured by immunoassays, which can return inaccurate results. Objective Establish whether differences in aldosterone measurements by immunoassay versus mass spectrometry (MS) might impact confirmatory testing for PA. Methods This study, involving 240 patients tested using the SIT at five tertiary-care centers, assessed discordance between immunoassay and MS-based measurements of plasma aldosterone. Results Plasma aldosterone measured by Liaison and iSYS immunoassays were respectively 86% and 58% higher than by MS. With an immunoassay-based SIT cut-off for aldosterone of 170 pmol/L, 78 and 162 patients had respective negative and positive results. All former patients had MS-based measurements of aldosterone &lt;117 pmol/L, below MS-based cutoffs of 162 pmol/L. Among the 162 patients with pathogenic SIT results, MS returned non-pathologic results in 62, including 32 under 117 pmol/L. Repeat measurements by an independent MS method confirmed non-pathogenic results in 53 patients with discordant results. Patients with discordant results showed a higher (P&lt;0.0001) prevalence of non-lateralized than lateralized adrenal aldosterone production than patients with concordant results (83%vs28%). Among patients with non-lateralized aldosterone production, 66% had discordant results. Discordance was more prevalent for the Liaison than iSYS immunoassay (32%vs16% P=0.0065) and was eliminated by plasma purification to remove interferents. Conclusions These findings raise concerns about the validity of immunoassay-based diagnosis of PA in over 60% of patients with presumed bilateral disease. We provide a simple solution to minimize immunoassay inaccuracy-associated misdiagnosis of PA.

On saline infusion, clonus, molecules and forgotten scientists: Who was Dr Julius Sander (1840–1909)?

Zitterbewegungen des Fusses bei Dorsalflexion (shaking movements of the foot upon dorsal flexion) were observed independently from each other and described in the same issue of a German peer reviewed journal by Carl Westphal (1833–1890) at the Charité in Berlin and by Wilhelm Erb (1840–1921) in Heidelberg. While Westphal used the term Fussphaenomen, Erb is credited with coining the term clonus for the phenomenon. Both scientists are immortalized by various eponyms acknowledging their respective contributions to science. Little is known however about Julius Sander (1840–1909), in those days resident at Charité, who noticed the phenomenon and presented it to his superiors, Wilhelm Griesinger (1817 −1868) and Westphal. In addition to such observations, Sander made original contributions in resuscitation physiology while working with Hugo Kronecker (1839–1914). With Kronecker, Sander published observations on life saving transfusions with inorganic salt solutions in dogs “ Bemerkung über lebensrettende Transfusion mit anorganischer Salzlösung bei Hunden” a very early work on isovolemic fluid resuscitation. The purpose of this communication is to highlight Sander's scientific contributions and to shed some light on his life, of which a German Lexicon stated that after 1870 no information on him can be ascertained anymore.

452 Saline-induced coronary hyperaemia is mediated by intravascular haemolysis

Aims Absolute coronary blood flow can be measured by intracoronary continuous thermodilution of saline through the lateral side holes of a dedicated infusion catheter placed in the proximal segment of the coronary artery. A room-temperature saline infusion rate at 15–20 ml/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear. The aim of the present study is to test whether local haemolysis is a potential mechanism of coronary hyperaemia. Methods and results Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured using the continuous intracoronary thermodilution of saline through a dedicated infusion catheter (RayFlow®). Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 ml/min); hyperaemia (Hyperaemia, saline infusion at 20 ml/min); post-hyperaemia [Post-Hyperaemia, 2 min after the cessation of saline infusion; and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min). Haemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperaemia phase. As compared to Rest, during Hyperaemia both LDH [131.50 ± 21.89 U/dL (Rest) and 258.33 ± 57.40 U/dl (Hyperaemia), P &lt; 0.001] and plasma-free haemoglobin [PFHb, 4.92 ± 3.82 mg/dl (Rest) and 108.42 ± 46.58 mg/dl (Hyperaemia), P &lt; 0.001] significantly increased in the coronary sinus. The percentage of haemolysis was significantly higher during the hyperaemia phase [0.04 ± 0.02% (Rest) vs. 0.89 ± 0.34% (Hyperaemia), P &lt; 0.001]. Conclusions Saline-induced hyperaemia through a dedicated intracoronary infusion catheter is associated with haemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation. The role of other substances released by erythrocytes in inducing hyperaemia cannot be excluded and requires further investigations.

Evaluation of Uterine Cavity Abnormality using Saline Infusion Sonohysterography Before In Vitro Fertilization

BACKGROUND: Some studies suggested that saline infusion sonohysterography (SIS) has been used to detect uterine cavity abnormalities before in vitro fertilization (IVF) cycles to improve treatment success rates and decrease the number of cycle cancellations and embryo implantation failures. Some of the factors contributing to the dissemination and acceptance of the technique include the fact that it is a simple, less painful, less expensive, less invasive, and well-tolerated procedure when compared to hysteroscopy. AIM: The aim of the study is to evaluate uterine cavity abnormality with SIS performed before IVF. METHODS: A descriptive retrospective study involving 551 female partners who had SIS before IVF/ICSI treatment at private Halim Fertility Center from January 2014 until December 2017. Five hundred and fifty-one infertile woman was included in this study before IVF/ICSI cycles. Patients agreed to have an ultrasound assessment of the uterine cavity with the use of saline as the contrast medium. SIS procedure was scheduled postmenstrual period in the early-mid follicular phase and 1-3 months before starting IVF/ICSI treatment. RESULTS: From 551 patients, we found 527 (94.4%) cases with the normal uterine cavity. The uterine cavity abnormalities were detected in 5.56% of cases included in this study (28 (5.02%) cases with endometrial polyps, two (0.36%) cases with intrauterine adhesions, and one (0.18%) case with Müllerian duct anomalies). CONCLUSION: SIS before IVF treatment could be a good option for evaluating uterus cavity before IVF to improve success rates of pregnancy.

Beneficial Effect of Sodium Nitrite on EEG Ischaemic Markers in Patients with Subarachnoid Haemorrhage

Subarachnoid haemorrhage (SAH) is associated with long-term disability, serious reduction in quality of life and significant mortality. Early brain injury (EBI) refers to the pathological changes in cerebral metabolism and blood flow that happen in the first few days after ictus and may lead on to delayed cerebral ischaemia (DCI). A disruption of the nitric oxide (NO) pathway is hypothesised as a key mechanism underlying EBI. A decrease in the alpha-delta power ratio (ADR) of the electroencephalogram has been related to cerebral ischaemia. In an experimental medicine study, we tested the hypothesis that intravenous sodium nitrite, an NO donor, would lead to increases in ADR. We studied 33 patients with acute aneurysmal SAH in the EBI phase. Participants were randomised to either sodium nitrite or saline infusion for 1 h. EEG measurements were taken before the start of and during the infusion. Twenty-eight patients did not develop DCI and five patients developed DCI. In the patients who did not develop DCI, we found an increase in ADR during sodium nitrite versus saline infusion. In the five patients who developed DCI, we did not observe a consistent pattern of ADR changes. We suggest that ADR power changes in response to nitrite infusion reflect a NO-mediated reduction in cerebral ischaemia and increase in perfusion, adding further evidence to the role of the NO pathway in EBI after SAH. Our findings provide the basis for future clinical trials employing NO donors after SAH.