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Ultrasound-Guided Biopsy Method Allows Improved Diagnosis of Endometrial Disease

By MedImaging International staff writers
Posted on 13 May 2009

A procedure used in conjunction with a vaginal ultrasound exam might make it easier to visualize and diagnose diseases in the lining of the uterus.

Researchers from the University of Texas (UT) Southwestern Medical Center (Dallas, TX, USA) evaluated the endometrium, a cavity that lines the inside of the uterus, in women who were in the midst of or had gone through menopause and who complained of abnormal bleeding. Abnormal bleeding can indicate certain diseases of the endometrium that may or may not be malignant.

The current standard of care is to blindly biopsy the endometrium; however, the biopsy might not always sample the part of the cavity that is diseased. The study, available online and in the April 2009 issue of the journal Obstetrics and Gynecology, revealed that using saline-infusion sonography (SIS), or ultrasound, a minimally invasive procedure, allows clinicians to actually see where in the endometrium a polyp or growth exists and to biopsy it accordingly.

"Saline infusion sonography augments the usual transvaginal sonogram and lets us see what is inside the endometrium," said Dr. Elysia Moschos, associate professor of obstetrics and gynecology at UT Southwestern and the lead author of the study. "Normally, the endometrial cavity is collapsed, but when we infuse it with saline, we can visualize inside the cavity and see if it contains any abnormalities."

On a sonogram, water appears dark and tissue is light, therefore, polyps or tumors look bright in comparison with the surrounding saline solution. Using the SIS procedure, physicians inject saline through a catheter threaded into the uterus through the cervix to fill up and expand the endometrial cavity. Physicians can then easily visualize and biopsy an existing growth under sonographic guidance and send it to a pathologist for analysis. A total of 88 saline-infusion sonography endometrial samples were obtained. In the final outcome of 80 of those samples, saline-infusion endometrial sampling provided a diagnosis 89% of the time, compared with 52% for endometrial biopsy.

The study showed there were no women for whom blind biopsy of the endometrium would still be an appropriate first step, according to Dr. Moschos. The blind biopsies missed 15 of 16 benign polyps and one-third of cancers. By comparison, two-thirds of benign polyps were correctly diagnosed by saline-infusion sonography endometrial sampling and no premalignant or malignant growths were missed.

Abnormal bleeding is a common complaint among patients, particularly during and after menopause. Women experiencing this symptom need to be evaluated for any kind of gynecologic cancers, according to Dr. Moschos. The first step should be imaging of the endometrium by ultrasound.

According to the American College of Obstetrics and Gynecology, postmenopausal women who have an endometrial lining thicker than 4 mm require additional follow-up. "In women with abnormal endometrial appearances, SIS should then be performed. If the endometrium is uniformly thickened on the SIS exam, only then is a blind biopsy appropriate," Dr. Moschos said. "However, most endometrial pathology is focal, and therefore directed sampling, such as with saline infusion sonography guidance, is necessary."

The patients were all evaluated at Parkland Health and Hospital System (Dallas, TX, USA), the primary teaching hospital for UT Southwestern faculty physicians.

Related Links:
University of Texas Southwestern Medical Center

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58 (!!!!! 8151.7696380615): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

59 (!!!!! 23960.113525391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

60 (!!!!! 7740.9744262695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

61 (!!!!! 3530.0254821777): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 1149.8928070068): SELECT fid FROM jos_deeppockets WHERE id=294723190 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723190 AND published='1' LIMIT 1

63 (790.83442687988): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

64 (!!!!! 1617.1932220459): select jos_twitters.link from jos_twitters where cat=10

65 (380.03921508789): select jos_facebook.link from jos_facebook where cat=10

66 (100.13580322266): select jos_google_plus.link from jos_google_plus where cat=10

67 (281.81076049805): select jos_linkedin.link from jos_linkedin where cat=10

68 (294.92378234863): SELECT fid FROM jos_deeppockets WHERE id=294723190 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294723190 AND published='1' LIMIT 1

69 (64.13459777832): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

70 (!!!!! 2253.0555725098): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (598.19221496582): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (344.03800964355): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 1397.1328735352): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (196.93374633789): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (138.0443572998): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (63.180923461914): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (452.99530029297): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (129.93812561035): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (560.99891662598): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (74.148178100586): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (213.1462097168): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (265.12145996094): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (231.98127746582): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (117.06352233887): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (805.13954162598): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 9454.0119171143): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (64.849853515625): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (67.949295043945): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1963.8538360596): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (73.19450378418): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 6600.1415252686): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (797.03330993652): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (583.17184448242): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (237.94174194336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (966.07208251953): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 1343.0118560791): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (357.86628723145): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (253.91578674316): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (756.97898864746): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (258.9225769043): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1487.9703521729): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

105 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

106 (567.91305541992): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (655.17425537109): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2384.9010467529): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

109 (580.0724029541): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

110 (288.96331787109): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 2989.0537261963): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1465.0821685791): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (578.16505432129): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 1811.9812011719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

115 (227.92816162109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

116 (946.99859619141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

117 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

118 (!!!!! 1553.0586242676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

119 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

120 (331.87866210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

121 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

122 (!!!!! 2478.1227111816): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 58905.124664307): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 1327.0378112793): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723190 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723190 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (47.922134399414): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (181.91337585449): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (889.06288146973): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (95.129013061523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (471.11511230469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (141.14379882812): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (216.96090698242): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (326.87187194824): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (!!!!! 4079.8187255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (66.995620727539): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 2218.0080413818): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1064.0621185303): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 8000.8506774902): SELECT name FROM jos_deeppockets WHERE id=214

138 (!!!!! 1940.9656524658): SELECT name FROM jos_deeppockets WHERE id=214

139 (!!!!! 1405.9543609619): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 10461.091995239): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 5478.8589477539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

142 (!!!!! 3545.0458526611): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

143 (!!!!! 4012.8231048584): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 2639.0552520752): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (103.95050048828): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294723190 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (468.96934509277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

149 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

150 (!!!!! 1132.9650878906): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

152 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

153 (40.054321289062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294723190 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294723190 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (496.14906311035): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

155 (!!!!! 6544.828414917): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (102.99682617188): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (148.05793762207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

158 (!!!!! 3715.0382995605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294723190 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294723190 AND published='1' LIMIT 1

159 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

160 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

161 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

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