This simple presentation was designed as a part of the basic ultrasound knowledge for junior clinicians held half annually in the Department of Obstetrics and Gynecology - Mansoura University- Egypt, as a component of continuous medical education offered by the department.
This presentation deals with how to perform ultrasound examination in the field of Gynecology.
I hope this is useful for under graduate students of medicine.
This presentation deals with how to perform ultrasound examination in the field of Gynecology.
I hope this is useful for under graduate students of medicine.
IVF has taken us as far as it can with embryo quality now that screening of embryos with PGS is becoming routine. Yet only half of chromosomally normal embryos implant to become a viable pregnancy. Our attention must turn towards the uterus and the receptivity of its lining, the endometrium. Chinese medicine may be able to lead the way with helpful interventions to improve the quality of the lining.
Post-graduate Certifcate Musculoskeletal Ultrasound - The ShoulderDr. Peter Resteghini
Lecture from The Post-graduate Certificate Musculoskeletal Ultrasound: Dr. Peter Resteghini
Course Director Post-graduate Certificate Musculoskeletal Ultrasound - http://www.uel.ac.uk/study/courses/Musculoskeletal.htm
Understand the history and pathophysiology of endometriosis
Understand the critical need for timely diagnosis and effective intervention
Understand the considerable effects and cost burdens of this chronic disease and employ best-practice techniques to mitigate them
Endometriosis an overview by dr. sharda Jain, Dr. Jyoti Agarwal , Dr. Jy...Lifecare Centre
Endometriosis :An Overview
Presented in Endometriosis update in Delhi June (2016) Hotel Leela
EB Guidelines
RCOG: Evidence-based Clinical, 1999
Endometriosis and infertility. ASRM, 2004.
ACOG. Endometriosis in adolescents, 2005.
ESHRE guideline for the diagnosis and treatment of endometriosis, 2005.
Endometriosis and infertility. ASRM, 2006.
Endometriosis: diagnosis and management.
Fertility: Assessment and Treatment for People with Fertility Problems. NICE, 2013.
ESHRE guideline: management of women with endometriosis,2014.
This simple lecture was designed as a part of the content of the basic ultrasound workshop held periodically by the department of Obstetrics & gynecology - Faculty of medicine - Mansoura university- Egypt as a part of continuous medical education program.
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Case Report:Massive Ovarian Cyst in a Adolescent GirlTana Kiak
For benign tumours adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue. There is scarcity of published literature on this subject.
We need bigger studies to address the issue of how much fertility preservation is safely possible.Irrespective of indication for surgery, it is always preferable to attempt conservative, fertility sparing surgery in adolescents.
Breast mass is a major concern. Aim of this study is to understand the tissue character of any breast mass, if it is solid then to decide about further strategy for regular follow up and or biopsy
Management of ovarian masses e Clinical situations & recommendations Apollo Hospitals
Adenexal mass is a common clinical presentation. This clinical situation is a problem that affects women of all ages. The biggest challenge is that one should not miss out on a diagnosis of malignant ovarian tumor. An ovarian mass or cyst that raises the suspicion of malignancy is a common dilemma in a gynecological practice. In the United States, a woman has a 5-10% lifetime risk of undergoing surgery for a suspected ovarian neoplasm and an estimated 13e21% chance of this turning into a diagnosis of ovarian cancer. Most of the adnexal masses are benign but the first responsibility of the treating gynecologist is to exclude malignancy. Management decisions often are influenced by the age and family history and presentation of the patient.
Polycystic ovary syndrome (PCOS) is of clinical and public health importance as it is very common in today’s era affecting women of reproductive age group. It has significant and diverse clinical implications including reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, adverse cardiovascular risk profiles) and psychological features (increased anxiety, depression and worsened quality of life).
Another commonest ovarian disorder is ovarian cyst. The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance.
In a regular Homoeopathic OPD the physician today encounter these two cases frequently. Most of the patients visiting with these disorders opt for Homoeopathy as an alternative treatment option to revert surgical procedures, or after failed hormonal therapies.
Homoeopathic management should focus on education, addressing psychological factors and strongly emphasizing healthy lifestyle with targeted medical therapy as required.
The present article discusses on various aspects of these ovarian disorders. Cases of Ovarian disorders which were successfully treated with homoeopathic medicines by the author are reported here.
Dr. Smita Brahmachari
M.O., Dept. of AYUSH, Govt. of NCT Delhi.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2. NORMAL GYNECOLOGICAL
ANATOMY- introduction
Ultrasound exam of the uterus & ovaries is best
performed trans-vaginally
The ultrasound morphology & size of the uterus
& ovaries change during the menstrual cycle.
In menopausal transition the ovaries are
smaller & contain fewer follicles than during
reproductive years. They continue to shrink after
the menopause, when the uterus also becomes
smaller.
Warda12 May 2014
3. NORMAL GYNECOLOGICAL
ANATOMY- introduction
A small amount of fluid in the pouch of Douglas is normal in
women of fertile age but abnormal after the menopause.
Normal tubes can only be seen if they float freely in fluid in
the pouch of Douglas .
On saline infusion sonography a normal uterine cavity is
regular and outlined by smooth endometrium.
hystero-contrast salingosonography is used to assess tubal
patency. If one can observe moving contrast in the interstitial
part of the tube for 10 seconds, and if no hydrosalpinx is seen,
the tube is probably patent, even if free spill of contrast
around the ovary is not clearly seen.
-
Warda12 May 2014
4. Ultrasound of Normal uterus
The myometrium is homogeneous
Morphology of endometrium changes during menstrual
cycle
At beginning of cycle the uterus is small and endometrium
thin
In follicular phase, uterus increases in size and
endometrium becomes thicker and manifests ‘triple-layer’
appearance
After ovulation the ‘triple-layer’ appearance disappears and
the endometrium becomes homogeneously hyperechoic.
Warda12 May 2014
6. Ultrasound of Normal cervix
Ultrasound examination of the uterus should always start
with examination of the cervix.
The cervical canal should be identified & followed towards
the corpus uteri so that it can be seen to join the
endometrium .
This examination technique ensures that it is indeed the
uterus & the endometrium that have been identified.
The myometrium of a normal cervix is homogeneous. In late
proliferative phase of MC, clear fluid, corresponding to
ovulatory cervical mucus, can be seen in cervix.
The finding of many & even large retention cysts in the
cervix is normal.
Warda12 May 2014
9. Ultrasound of Normal ovary
Ovarian us morphology changes with the MC.
In the beginning of the MC both ovaries usually contain 6-
7 follicles of <10mm diameter.
The non-dominant ovary retains this appearance
throughout the MC .
In early FP, it is not possible to determine which ovary is
going to become the dominant one. It can be identified 6-
9d before the LH surge, i.e. between D5-D12 of the MC
(mean D8).
The DF displays a linear growth of ±1.7mm/day. At the
time of LH surge the DF = 18-22mm
Warda12 May 2014
10. Ultrasound of Normal ovary(contd.,)
After ovulation the follicle becomes a CL.
The CL is usually smaller than the DF, its wall is thicker, and with
high resolution US it is possible to see the crenellated appearance
of its wall. Bleeding into CL explains presence of internal echoes in
the CL at US.
The CL is well vascularized & therefore it is surrounded by a ‘color
ring’ or ‘fire ring’ on CD or PD ultrasound.
On the 3rd of MC the CL of the previous cycle is no longer
distinguishable even by CD ultrasound.
Ovarian size changes during MC , vol. of non-dominant ovary 7-8ml
remains unchanged, while DO increases from 7-8ml in FP to 20ml on
day befor ovulation
Warda12 May 2014
12. Normal US of uterus & ovary in
post-menopause
The uterus & ovaries are smaller in
postmenopausal women than in CBP.
A normal uterus in a woman 5 years
postmenopause = 5-6 length x2.5 AP x3 cm width.
Normal ovary volume=1-4ml & with no follicles
The endometrium is thin (<5mm), uniform (no
cyclic changes, and hyperechoic.
Calcified BV in the periphery of the myometrium
are common & seen as bright echoes.
Warda12 May 2014
15. GYNECOLOGICAL
MALIGNANCY-OVERVIEW
Gynecologic cancers represent 14% of all solid
tumors in women and 11% of deaths from them.
Cervical, uterine and ovarian cancer represent
95% of gynecologic cancers and collectively rank
the fourth in both incidence and mortality
among cancers that affect women in developed
countries.
Worldwide, these tumors account for even
larger share of cancer mortality in women
Warda12 May 2014
16. Number of Cases of Cancer
Cervix in Egypt, Jordan, USA
EGYPT
(1999-2001)
JORDAN
(1996-2001)
USA
(1999-2001)
TOTAL per
100,000
96 194 5284
Age distribution
(Years)
30-49 38.5% 45.3% 48.4%
50-69 52.1% 42.8% 36.2%
70+ 9.4% 11.9% 15.4%
Warda12 May 2014
17. Endometrial carcinoma
Worldwide it represents 3.9% of female
cancers
It is more common in developed countries :
18/100,000 in USA & Canada compared to
6/100,000 in Africa and is related to:
- Prolonged high estrogen levels
- Few number of children
- Use of HRT
Warda12 May 2014
18. Number of cases of Endometrial
Carcinoma in Egypt, Jordan, USA
Egypt
(1999-2001)
Jordan
(1996-2001)
USA
(1999-2001)
Total per
100,000
124 405 14129
Age
distribution
%
<50 33.1 26 15.5
50-69 56.4 50.5 49.9
70+ 10.5 13.1 34.6
Warda12 May 2014
19. Ovarian cancer
Epithelial ovarian carcinoma account for
90% of cases and is the leading cause of
death in women with pelvic malignancies
The incidence is higher in industrial
countries of the world
Women who are single and have low
parity and a history of breast cancer are
at risk.
Warda12 May 2014
20. Age-standard incidence rate of Ovarian
Carcinoma in Egypt, Jordan , USA
TOTAL per
100,000
Egypt
1999-2001
Jordan
1996-2001
USA
1999-2001
All ages 5.4 4.6 10
<50 2.5 2.1 3.2
50-69 17.7 14.1 33.5
70+ 14.9 17.3 52.7
Warda12 May 2014
21. Ovarian Pathology
Warda
Haemorragic cyst. Small unilocular cyst, with some internal echoes, irregularly
distributed. Thick, but smooth wall, absence of papillary projections. Normal ovarian
tissue is visible medially. The picture is typical for haemorragic cyst/corpus luteum.
12 May 2014
23. Ovarian Pathology
Warda
Slightly enlarged "solid" ovary in a woman of 63 years of age. The texture is
moderately inhomogeneous. Marigin irregular but well defined. Histology confirmed
the presence of a benign ovarian fibroma.12 May 2014
24. Ovarian Pathology
Warda
Unilocular ovarian cyst. "Ground glass" hypoecoic texture, slightly thickened
but regular margins, some normal ovarian tissue is visible cranially, around
the cyst. The picture is very suggestive for an ovarian endometrioma.
12 May 2014
25. Ovarian Pathology
Warda
Small dermoid in an otherwise normal sized ovary. Note the homogeneous,
hyperechoic texture typical of a dermoid cyst. In this case shadowing was not
detectable.
12 May 2014
26. Ovarian Pathology
Warda
Power Doppler well depict blood vessels around a normal sized corpus luteum, with
the typical aspect of a "ring of fire".
12 May 2014
27. Ovarian Pathology
Warda
Unilocular ovarian cyst, few small papillary intracavitarian projections deform
the caudal portion of the cyctic wall, otherwise smooth. Internal echoes are
regularly distributed, with a "ground glass" texture. Histology confirmed the
presence of a border-line ovarian cystadenoma of endometrioic type.
12 May 2014
28. Ovarian Pathology
Warda
Unilocular ovarian cyst, with "ground glass" internal texture, suggestive of endometrioma. A
small "papillary-like" projection, deforms the lateral wall of the cyst. This an example of
socolled "atypical endometrioma". In such cases, Power Doppler analysis is very useful to
differentiate it from a true neoplasm.
12 May 2014
29. Ovarian Pathology
Warda
Small multilocular solid ovarian cyst, with few small septa and papillary projections. As such
the picture would appear highly suspicious for malignancy. Subsequent evaluation with
power and pulsed Doppler showed however, scanty vascularity and high impedance to
blood flow. Histology demonstrated a benign cystic ovarian adenofibroma.
12 May 2014
30. Ovarian Pathology
Warda
Multilocular ovarian cyst. Several septa of different length and thickness, but no
papillary projections or solid areas are present. Margins are well defined. Internal
echoes are scanty. Histology diagnosed a benign ovarian cystadenoma of serous type.
12 May 2014
31. Ovarian Pathology
Warda
A small, round shape unilocular cyst, close but external to the ovary,
suggestive to be a paraovary cyst.
12 May 2014
32. Ovarian Pathology
Warda
The ovary is enlarged, solid, with undefined margin, slightly unhomogeneous
texture. Normal ovarian texture is not visible. The picture is suggestive of a
primary malignant ovarian neoplasm or of an ovarian metastasis.
12 May 2014
33. Ovarian Pathology
Warda
Unilocular solid ovarian cyst, with 2 large intracavitarian solid, papillary areas,
occupying almost 1/3 of the lumen of the cyst. Internal echoes are visible. Histology
diagnosed a malignant cystadenocarcinoma of serious type.
12 May 2014
34. Ovarian Pathology
Warda
Very large (>22 cm) multilocular solid ovarian cyst. There are many
septations forming a thick "web" and solid intra-cavitarian areas.
Internal echoes are abundant. The picture is suggestive of a malignant
cystadenocarcinoma of mucinous type.
12 May 2014
35. Ovarian Pathology
Warda
Enlarged, "solid" ovarian mass. Power Doppler show intense vascularisation.
At histology an ovarian metastasis of breast cancer was diagnosed.
12 May 2014
36. Ovarian Pathology
Warda
Large ovarian solid tumor. Texture is homogeneous, margins are well
defined. At histology a granulosa cell tumor was diagnosed.
12 May 2014
37. Ovarian Pathology
Warda
Superimposed power Doppler examination of a solid ovarian mass
proved to be a granulosa cell tumor. Showing abundant and
irregularly distributed vascularisation.
12 May 2014
38. Ovarian Pathology
Warda
Pulsed Doppler examination of blood flow impedance in an ovarian solid mass, proved to be a
granulosa cell tumor. Maximum velocity is high and impedance to flow low.
12 May 2014
47. Uterine Pathology
Warda
Submucous fibroid polyp/ sonohysterography+ CD
Enlarged uterus in a 53-year-old woman with abnormal bleeding. The uterus is enlarged
slightly and heterogeneous in echotexture but has no focal masses. Histologic
examination revealed adenomyosis.
12 May 2014
49. Uterine Pathology
Warda
Submucous fibroid polyp/ sonohysterography+ CDCervical masses. (A) Sagittal view of the cervix demonstrates a large
cervical fibroid which deviates the lower uterine segment anteriorly.
fibroid
Uterus
12 May 2014