English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

138 Sakin et al., Genital Effects of Tamoxifen / doi: 10.14744/hnhj.2018.52244 changes such as, endometrial hyperplasia, endometrial thickening, ovarian cysts, endometrial polyps, increase in the size of uterine fibroids, flare up or regression in endometriotic foci, and cervical and vaginal changes may occur [4-6]. It is imperative to detect these premalignant and malignant changes early using minimally invasive techniques in order to avoid unnecessary invasive techniques and procedures. Power Doppler ultrasound assessment gives us useful information about these patients and secondary information about vascular changes in the tumoral structures that are detected [7]. Our aim was to investigate uterine vascular and endometrial structural and vascular changes with power Doppler ultrasound in patients with breast cancer and to evaluate the success of detecting benign or malignant lesions in tamoxifen users and non-users. Materials and Methods Among patients who were treated for breast cancer between 1993 and 2010 at our hospital, 111 patients agreed to participate in the study. We included all patients who had been diagnosed with breast cancer and who had not undergone a hysterectomy operation. We excluded women with severe systemic medical conditions (heart failure, uncontrolled severe hypertension, etc.), cervical stenosis, acute cervicitis / vaginitis, or lidocaine allergy. This prospective case control study was performed with the permission of the local ethics control committee and informed consent was obtained from all patients. Transvaginal ultrasound, color Doppler, and power Doppler evaluations were done and findings were noted. Uterine volume, adnexal and endometrial features (thickness, homogeneity, fluid collection, cystic changes, polyps view), abnormal vascular forms (single vessel pattern, scattered vascular pattern, multiple vascular pattern), uterine artery Doppler pulsatility index (PI), resistance index (RI), and systole/diastole ratio (S/D) measurements were done routinely to all patients. Endometrial biopsies were performed under local anesthesia in patients who agreed to undergo the procedure and in patients with an endometrial thickness above 5 millimeters. Patients were taken to the gynecological examination table in the dorsal lithotomy position. All women underwent bimanual pelvic examination to determine the size and position of uterus. Cervix was exposed with a bivalve speculum and washed with povidine-iodine solution. 2 ml 2% lidocaine (Iekaine Ampoule, IE Ulagay, Istanbul, Turkey) was injected into the cervix at the 4 and 8 o'clock positions and at the depth of 2-3 cm after confirming the tip of needle was not inside a vessel lumen. Five minutes were allowed to pass to ensure that the anesthetic effect of lidocaine had started. The biopsies were taken with a Pipelle cannula or uterine curettes after dilatation of the cervix. Specimens were pathologically delivered in 10% buffered formaldehyde and paraffin blocks were formed afterwards. Selected paraffin sections of 4 μm thicknesses were evaluated by using an Olympus microscope (Olympus Life Science Solutions, Florida, America), at x10–x400 power magnifications. The pathological results of endometrial biopsies were recorded. Patient age, marital status, socioeconomic status, educational status, working status, body mass index, habits, personal history, family history, pregnancy history, age of menarche, duration of menopause, existence of postmenopausal bleeding, tamoxifen usage, history of chemotherapy or radiotherapy were all recorded from the patients’ files. Transvaginal ultrasound, color Doppler, and power Doppler evaluations were done with a 7 MHz (bandwidth 4.3-8.6 MHz, viewing angle width 121 ̊) 70 ECLA vaginal probe in an Siemens Accuson Antares ultrasound machine (Siemens Healthcare Diagnostics, Tarrytown, America). Sagittal sections of the uterus were evaluated by placing the vaginal probe to the posterior fornix. Morphologies of transverse, longitudinal, and antero-posterior planes were evaluated. Longitudinal length of the uterus was measured as the distance between the apex of uterus and the end of the cervix by imaging the fundus and the cervix in the same plane; and the length was recorded in millimeters (mm). Fundal and cervical antero-posterior diameters were measured. The uterus was imagined as an ellipsoid shape and the volume was calculated with the D1xD2xD3x0.52 formula. Presence of myomas and adenomyosis were recorded. Pattern of endometrial echo with continuity of subendometrial halo, density, homogeneity, endometrial contour, presence of cystic appearances, liquid accumulation, and presence of polyp images were evaluated. In order to investigate whether tamoxifen caused any changes in the uterine blood flow, PI, RI, S/D values from uterine arteries was detected with color Doppler and vascular changes were evaluated with power Doppler. Lowest PI and RI values in the vessels were recorded using at least three consecutive waveforms. All evaluations were made by the same physician. SPSS for Windows v. 15.0 program was used for statistical analysis. Dependent variables in the two groups were evaluated with the student’s t test; quantitative data were evaluated with chi-square test. Statistical significance was set at p<0.05. 139 Sakin et al., Genital Effects of Tamoxifen / doi: 10.14744/hnhj.2018.52244

haydarpaşa numune hastanesi tıp dergisi

Evaluation of endometrial changes with transvaginal power Doppler ultrasound and comparing them with endometrial sampling in breast cancer patients that are using tamoxifen