Tehran University Medical Journal

Background: Abnormal uterine bleeding (AUB) is a common presenting symptom indicative of abnormal menstrual bleeding patterns that may occur in anovulatory or ovulatory women.There are different ways to diagnose AUB, all requiring much time and energy. The purpose of this study was to evaluate and compare the value of endometrial biopsy, transvaginal ultrasonography with dilation and curettage (D&C) which is the current gold standard procedure.

Methods: A prospective-descriptive study was conducted on fifty patients referred to our center for refractory abnormal uterine bleeding who were candidates for hysterectomy. All patients underwent endometrial biopsy and transvaginal ultrasonography , followed by D&C as a Gold standard procedure in operating room just before surgery.

Results: Mean age of patients was 46.62 years. Transvaginal utrasonography offered a sensitivity of 70% and specificity of 68% demonstrating the lowest numbers compared to D&C. Endometrial biopsy had a sensitivity of 70% and specificity of 75% that was better than sonography alone.

Conclusion: D&C was the most useful and valuable procedure and addition of endometrial biopsy with transvaginal ultrasonography will not be of high value in diagnosis.

Background: Cirrhosis and portal hypertension influence the hepatic circulation. The purpose of this study was to evaluate the diagnostic accuracy of liver Doppler ultrasonography parameters in cirrhosis.

Methods: This case-control study involved 118 subjects. All case subjects had biopsy-proven hepatic cirrhosis. The controls were healthy people, case-matched for age and gender. All cases and controls underwent Doppler ultrasonographic evaluation. We compared the area under the ROC curve of each parameter for cases vs. controls using Fisher's exact test, with p <0.5 indicating significance.

Results: The means of the following parameters for case vs. control subjects were: frequency of portal venous flow inversion, portal vein diameter 12.67±2.72 vs. 10.59±1.69, and hepatic arterial resistance index 0.81±0.07 vs. 0.74±0.09. The mean hepatic artery pulsatility index (1.87±0.48 vs. 1.34±0.23), was significantly higher among the case subjects (P=0.001). The maximum flow rate of the portal vein was also significantly lower in the case subjects (16.50±5.59 vs. 36.74±8.74 cm/s, P=0.001). We did not observe significant differences in the means of the hepatic artery maximum flow rate and end-diastolic flow rate. For diagnosing cirrhosis, the application of 24.1 cm/s as the cutoff point for the portal vein maximum flow rate, we obtain an accuracy of 95.45% (91.23%-97.70%, CI=95%), whereas a cutoff point of 1.54 or more for the hepatic artery pulsatility index yields an accuracy of 85.71% (79.48%-90.29%, CI=95%). Utilizing a hepatic arterial resistance index of 0.765 or greater is associated with an accuracy of 71.05% (62.81%-78.11%, CI=95%) in diagnosing cirrhosis.

Conclusions: Doppler ultrasonography and assessment of hepatic artery and portal vein parameters are accurate methods in the diagnosis of cirrhosis.

Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Successful brachial plexus blocks rely on proper techniques of nerve localization, needle placement, and local anesthetic injection. Standard approaches used today (elicitation of paresthesia or nerve-stimulated muscle contraction), unfortunately, are all "blind" techniques resulting in procedure-related pain and complications. Ultrasound guidance for brachial plexus blocks can potentially improve success and complication rates. This study presents the ultrasound-guided brachial plexus blocks for the first time in Iran in adults and pediatrics.
Methods: In this study ultrasound-guided brachial plexus blocks in 30 patients (25 adults & 5 pediatrics) scheduled for an elective upper extremity surgery, are introduced. Ultrasound imaging was used to identify the brachial plexus before the block, guide the block needle to reach target nerves, and visualize the pattern of local anesthetic spread. Needle position was further confirmed by nerve stimulation before injection. Besides basic variables, block approach, block time, postoperative analgesia duration (VAS<3 was considered as target pain control) opioid consumption during surgery, patient satisfaction and block related complications were reported.
Results: Mean adult age was 35.5±15 and in pediatric group was 5.2±4. Frequency of interscalene, supraclavicular, axillary approaches to brachial plexus in adults was 5, 7, 13 respectively. In pediatrics, only supraclavicular approach was accomplished. Mean postoperative analgesia time in adults was 8.5±4 and in pediatrics was 10.8±2. No block related complication were observed and no supplementary, were needed.

Conclusions: Real-time ultrasound imaging during brachial plexus blocks can facilitate nerve localization and needle placement and examine the pattern and extend of local anesthetic spread.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Preterm delivery is a relevant public health problem since it is an important factor determinant of morbidity and the main reason for neonatal mortality. Many publications have pointed at clinical methods, biological, biochemical and ultrasonographic markers, which applied in combination or on their own, aim at predicting spontaneous preterm delivery. Transvaginal sonography is an effective method for the study of uterine cervix during pregnancy since it permits to assess the cervical morphology and biometry in detail with a high degree of reliability. The aim of this study was to evaluate the association between spontaneous preterm delivery (SPTD) before 35 and 37 weeks of gestational age, in high risk population and the measurement of the cervix length and cervical funneling.

Methods: A prospective cohort of 200 women carrying high risk pregnancies were evaluated by transvaginal sonography between 14th and 28th weeks of gestation.
Results: Cervical length less than 18mm before 35th and 37th weeks of gestational age and the presence of cervical funneling presented a satistically significant association with spontaneous preterm delivery before 35 weeks. The cervical length with less 18 mm demonstrated a strong association with SPTD before 37 weeks (p<0.005 OR=92.15) and before 35 weeks' gestation (p<0.001 OR=32.33). The logistic regression analysis suggested the cervical length with less than 18mm as the only variable that revealed satistically significance association with SPTD.
Conclusion: The results seem to indicate that the assessment of cervical length is an important ultrasound marker for predicting spontaneous preterm delivery.

Background: High Resolution sonography of common carotid artery is a safe method for rapid diagnosis of atherosclerosis in Rheumatoid Arthritis (RA). The purpose of this study was to compare sonographic findings of subclinical atherosclerosis in rheumatoid arthritis patients and control group and comparing the prevalence of atheromatous plaques and Intima- media thickness in arteries of the groups.

Methods: Fifty RA patients and fifty non-RA persons were evaluated in a cross- sectional, Descriptive study. The sonographic findings of common carotid artery of these two groups were compared.

Results: After analysis of the sonographic findings of common carotid arteries of 100 females in our study (50 patients with the mean age of 48.1y/o [23-61] and 50 control group with the mean age of 47y/o [23-61]), the prevalence of RA patients with atheromatous plaques was 32% and in control group was 6%. [OR=7.4, 95%CI=2-27.3, p=0.001]. The mean (SD) of the Intima- Media Thickness (IMT) in RA patients was 7.76 mm (1, 04) while in control group was 6.10 mm (0.95). From 38 RA patients with less or equal 5 joints involvement in hand radiography, 13.2% had atheromatous plaques and the mean (SD) of the IMT was 7.6 (±1.1) mm. From 12 patients with more than 5 joints involvement in radiography, 91.7% had atheromatous plaques and the mean (SD) of the IMT was 8.4 (±0.7) mm. [p=0.012].

Conclusions: Regarding higher prevalence of vascular problems in RA patients, screening and early diagnosis of vascular pathologies could be of value in reducing morbidity and mortality of these patients.

Background: Detection of retained foreign bodies remains a significant problem in the emergency department. Foreign bodies can go undetected causing infectious complications ultrasonography is too inaccessible and expensive. The purpose of this study is comparison of ultrasonography with radiography for the detection of cervical esophageal foreign bodies
Methods: This cross-sectional study evaluated 58 patients referred with suspected upper esophageal foreign body in the Emergency Department, Amir Alam. Patients were evaluated with ultrasonography and x-ray. After surgical exploration, different type of foreign bodies were recorded. The SPSS statistical software was used for analysis. For applicable efficacy outcome measures, a Spearman correlation was used. Differences were significant when P<0.05. All values were expressed as the frequency and present.
Results: Fifty eight patients were studied. 25 patients (43.4%) were male and 31 patients (56.9%) were female, in 28 (48.2%) patients foreign bodies were detected in radiography. 30 patients (51.8%) were not recorded in techniqe. It was found in patients 22 (78.6%) organic body, and six cases (21.4%) non-organic body. radiographic outcomes in patients with foreign bodies were positive in 26 patients (92.9%) and in two patients (7.1%) were negative. Ultrasound results were positive in 27 patients (96.4%) and in one patient (3.6%) were negative. Association of ultrasound and radiography results were significant in patients with foreign body (Spearman correlation=0.896, P=0.001 Kappa=0.890).
Conclusion: These reports suggest that result of ultrasound with radiography for the detection foreign bodies in cervical esophagus have good agreement. The use of ultrasonography in the emergency department to detect and eventually remove foreign bodies by emergency physicians is an important issue because there is not always an ultrasound technologist or radiologist available.

Background: The primary manifestation of cardiac tumors in embryonic period is a very rare condition. Cardiac rhabdomyomas most frequently arise in the ventricular myocardium, they may also occur in the atria and the epicardial surface. In spite of its benign nature, the critical location of the tumor inside the heart can lead to lethal arrhythmias and chamber obstruction. Multiple rhabdomyomas are strongly associated with tuberous sclerosis which is associated with mental retardation and epilepsy of variable severity. Ultrasonography as a part of routine prenatal screening, is the best method for the diagnosis of cardiac rhabdomyomas. In the review of articles published in Iran, fetal cardiac rhabdomyoma was not reported.

Case presentation: We report a case of cardiac rhabdomyoma on a 24-year-old gravid 1, referred to Day Medical Imaging Center for routine evaluation of fetal abnormalities at 31 weeks of her gestational age. Ultrasonographic examination displayed a homogenous echogenic mass (13×9mm), originating from the left ventricle of the fetal heart. It was a normal pregnancy without any specific complications. Other organs of the fetus were found normal and no cardiac abnormalities were appeared. No Pericardial fluid effusion was found. The parents did not have consanguineous marriage. They did not also have any specific disease such as tuberous sclerosis.

Conclusion: The clinical features of cardiac rhabdomyomas vary widely, depending on the location, size, and number of tumors in the heart. Although cardiac rhabdomyoma is a benign tumor in many affected fetuses, an early prenatal diagnosis of the tumor is of great significance in making efficient planning and providing adequate follow up visits of the patients and the complications such as, heart failure and outlet obstruction of cardiac chambers.

Background: Lochia is the slight vaginal bleeding between 24 hour to 12 week after delivery. There isn't any standard definition for difference between normal and abnormal lochia in post-partum period. The aim of this study was to determine the relationship between ultrasonic findings of the postpartum uterus after normal vaginal delivery with the duration of lochia discharge.

Methods: In this cross-sectional study was done in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2015. In this study 160 women with non-complicated vaginal delivery were entered. Inclusion criteria were: Term pregnancy with gestational age > 37, singleton fetus with cephalic presentation. Exclusion criteria were pre-term pregnancies, previous Cesarean section or other uterine surgeries and twin fetuses. Transvaginal ultrasound was done in first 48 hours after delivery, endometrial thickness echogenicity and uterine size was evaluated. Maternal age, parity, duration of labor and neonatal weight were evaluated. Then the mothers were followed for 6 weeks. The quality and the quantity of lochia discharge were asked by the phone.

Results: Lochial discharge last more than 6 weeks in 96 out of 160 (60%). One had less than 4 weeks. The uterus length, thickness, height and endometrial length did not show any relationship with the duration of lochial discharge, but endometrial strip thickness significantly correlated with the duration of lochial discharge period (P=0.04). None of clinical variables like the number of gravidity, parity, live birth or child birth weight, were correlated to the duration of lochia discharge period, but the labor time was correlated to the duration of lochia discharge period (P=0.04). Although both endometrial thickness and labor time in univariate analysis were correlated to the lochia duration time but this was true just for endometrial thickness in multivariate analysis.

Background: Cerebral arteriovenous malformations are rare congenital anomalies presenting as different symptoms depending on their size and the age of patient. Congestive heart failure is a rare condition in neonatal period and is most common due to structural heart defects, but rarely may be a result of peripheral shunts such as cerebral arteriovenous malformation.

Case presentation: A term male newborn infant who was delivered by Caesarean Section in Chamran Hospital, Ferdows, South Khorasan Province, June 2016. The infant was admitted to neonatal care unit due to nonreactive nonstress (NST) with normal Apgar score. In first postpartum visit, a systolic heart murmur was detected. Echocardiography showed small atrial septal defect secundum type and patent foramen ovale (PFO). He presented clinical manifestations of heart failure after 72 hours of birth. Antibiotic and treatment of heart failure was started. Following excluding most common etiologies of heart failure such as sepsis, anemia and arrhythmias, for detecting less common conditions such as cerebral vascular aneurism a transfontanelle ultrasonography was performed which showed dilated cerebral venous system. Magnetic resonance imaging (MRI) and Magnetic resonance venography (MRV) revealed a large congenital cerebral arterio-venous malformation (CAVM), in right cerebral hemisphere. Finally, he was expired 9 days after birth due to severe heart failure before any definitive treatment for closing CAVM could be done.