To compare the effectiveness of histerosonography (HSG) with transvaginal ultrasonography and histeroscopy in patients with abnormal uterine bleeding (AUB), and the ability to reduce invasive procedures as histeroscopy. 97 patients with AUB. Medical history taken from all patients, gynaecologic examination, transvaginal sonography and histerosonography were done. During the HSG procedure endometrial thickness were measured and abnormal filling defects noted. Results were compared with anatomopatologic results of endometrial material. See Table 1. HSG increases sensibility, specificity and predictive positive value of TV sonography and in some clinics circumstances may avoid histeroscopy.
Sierra Leone is a low-income sub-Saharan country in the endemic Burkitt's lymphoma (BL) belt. We performed a prospective trial of a reduced-intensity chemotherapy protocol for the treatment of paediatric BL.The trial included all children clinically diagnosed with BL between 2005 and 2008. Biopsy, bone-marrow aspiration, analysis of cerebrospinal fluid, abdominal ultrasound and plain x-ray of involved sites were performed when feasible. The treatment protocol was a first i.v. dose of cyclophosphamide (CPM) 40 mg/kg, followed by oral CPM weekly for two doses and then bimonthly to a total of six doses. Treatment was based on clinical diagnosis as it was several weeks before pathology results were available.Eighty-seven patients were included, with a median age 7 years and 4 months; 59/87 (67.8%) were boys. Nearly half (n = 17, 42.5%), presented with moderate or severe malnutrition. Biopsy was performed in 44 patients, BL being verified in 36 (41.4% of all patients). Most children presented with advanced disease: 28 (32%) at stage II, 47 (54%) at stage III and 12 (13.8%) at stage IV. Most patients (71/87, 82%) initially responded to treatment, but just over half (47/87, 54%) experienced relapse and refractory disease. Forty patients (46%) in complete or partial clinical response were lost to follow-up.The outcome for BL in rural Sierra Leone according to this protocol is poor. Low-dose CPM was ineffective. Constraints on performing complete diagnosis and staging, frequency of advanced disease at presentation and a high drop-out rate might explain our poor results.