There have been numerous double-blind, randomised, dose-finding studies of the gonadotrophin-releasing hormone (Gn-RH) antagonist Ganirelix (Org 37462) and the Gn-RH antagonist Cetrorelix.
We performed a clinical trial with 26 patients undergoing ovarian stimulation with the recombinant human follicle stimulating hormone (FSH) by applying rec. FSH in a flexible daily dose, depending on the estradiol levels of the patient, from day 3 of the cycle onwards in a controlled ovarian hyperstimulation (COH) protocol. A single dose of 0.25 mg was injected daily subcutaneously from day 7 of the cycle onwards until the day of HCG application. The recombinant FSH dose was adjusted according to ovarian response. Fifteen patients were treated for IVF and nine for ICSI. In two patients egg retrieval was not performed. Estradiol and LH levels were measured on the day of HCG application.
The mean number of recovered oocytes in the 24 patients was 5.5. A fertilisation rate of 64% was achieved in the IVF group and 69% in the ICSI group. In Germany a maximum of three embryos per patient is permitted to be transferred. Pregnancy occurred in ten patients: 5 IVF patients and 5 ICSI patients. In this small group of IVF patients a 33% pregnancy rate per follicular puncture and a 50% pregnancy rate per embryo transfer resulted. The ICSI group showed a 55% pregnancy rate per follicular puncture and a 62% pregnancy rate per embryo transfer.
Within an IVF/ET, ICSI programme the Gn-RH-antagonist Cetrorelix in combination with rec. FSH gave optimal pregnancy results.
The purpose of the study was to determine the effects of low-dose hormone replacement therapy (HRT) on ultrasound thickness of the endometrium and on endometrial histology in postmenopausal women. Two hundred and fifty-four postmenopausal women were included in the study; 124 completed three years of treatment with continuous HRT containing 1 mg oestradiol and 0.5 mg norethisterone acetate daily, and 130 women did not take HRT during the same time (control group). Ultrasound scan showed that the mean thickness of the endometrium was similar between the groups under investigation at the end of the study. Ninety-one percent of the women in the HRT group and 78% in the control group had an atrophic or unassessable endometrium and no cases of endometrial hyperplasia or malignancy were detected in either group at endometrial biopsy at the end of the study. It seems that low-dose continuous HRT of moderate duration is not associated with either endometrial hyperplasia or malignancy.
To assess the activity of a pre-pregnancy counseling clinic in terms of investigations, counseling, treatment, and subsequent pregnancy outcome.
Prenatal diagnosis and therapy were given in a tertiary university hospital in Lagos offering referral services for fetal medicine.
Review of the first 1,000 couples who referred to the centre from various centres attended from 1992 to 2007. Main outcome measures were assessed through types of referrals, value of diagnostic tests, and subsequent pregnancy outcomes.
The main types of referral were previous miscarriage (48.2%), previous fetal abnormality (10.8%), chronic maternal illness (25.1%), and others (15.9%). Routine investigation showed high serological toxoplasmosis, rubella, cytomegalovirus, herpes simplex I, herpes simplex II (TORCH) positive antibodies carrier rate. Subsequent pregnancy outcome did improve in the chronic maternal diseases and previous miscarriage group.
This study illustrates the importance of making an accurate assessment of previous problem and current health as a means of determining both maternal and fetal risks in a subsequent pregnancy.
To assess factors that might influence the success rate, safety and reliability of amniocentesis.
A retrospective study analyzing of the outcome of the first 1,000 cases of amniocenteses.
The outpatient clinic of prenatal diagnosis and therapy laboratory of a University tertiary care centre.
A review of the first 1,000 amniocentesis procedures performed at the Prenatal Diagnosis and Therapy Centre is presented. Medical records were reviewed for maternal age, indication, color of amniotic fluid, gestational age, frequency of needle insertion, complications of amniocentesis, pre delivery results of prenatal testing and pregnancy outcome. Complete follow-up data were available for 968 (96.8%), and in 42 cases reports were not complete.
There were 21 miscarriages before 28 weeks of gestation (2.2%), three losses after 28 weeks (0.3%) and six stillbirths (0.6%) (4 due to infections) resulting in a total post procedural loss rate of 3.1% (30). Miscarriage within two weeks of amniocentesis occurred in six patients (0.62%).
Amniocentesis is a relatively safe and reliable method of prenatal diagnosis. It must be done by experienced personnel.
To investigate the indications of amniocentesis for the detection of chromosomal abnormalities among a sample of patients in Southeast Turkey.
Between 2004 and 2007, 1,068 second-trimester amniocentesis tests were performed in the Medical Biology and Genetics Department Laboratory at Dicle University. Amniotic fluids were cultured by using long-term tissue culture for prenatal diagnosis with cytogenetic analysis. The clinical and cytogenetic findings on 1,068 second-trimester amniocenteses were analyzed. The indications, the proportions of karyotypes according to indications and complications were summarized.
Among the 1,068 amniocentesis cases, the maternal age between 35 and 39 years was the most common age group (34.5%). Of the clinical indications abnormal maternal serum screening results were the most common indication for amniocentesis (37.6%). Of 52 cases (4.9%) with detected chromosomal aberrations, 39 were numeric (27 trisomies, 10 sex chromosome aberrations and two triploidies) and 13 were structural (2 reciprocal translocations, 2 Robertsonian translocations and 6 inversions). The highest detection rate of chromosome aberrations was in cases undergoing amniocentesis for abnormal maternal serum screening combined with abnormal ultrasound (US) findings (8.0%).
This study suggests that complementary measures, such as routine antenatal US and maternal serum screening, should be added to increase the efficiency of genetic amniocentesis. Therefore, the study could be used for the establishment of a database for genetic counseling.
While human oocytes have been successfully cryopreserved using traditional slow-rate freezing protocols, inconsistent results post-thaw have limited the routine clinical application of oocyte cryopreservation. Despite interest in the potential benefits of vitrification as an alternative laboratory approach to long-term oocyte preservation in assisted reproduction, there is little agreement on how best to configure such cryopreservation protocols to optimize oocyte viability. To comparepost-thaw oocyte survival rates,we performed cryoloop vitrification of human oocytes utilizing two different cryoprotectant mixtures that included polymer macromolecules. Human oocytes (n = 1120) were obtained from consenting patients undergoing in vitro fertilization, but only failed-matured (uninseminated) or failed-fertilized (inseminated but without 2pn development) were included in this investigation. Protocol A consisted of 20% ethylene glycol and 20% dimethyl sulphoxide + 0.4 M sucrose and 20% synthetic serum substitute. Protocol B consisted of 20% ethylene glycol and 20% dimethyl sulphoxide + 0.65 M sucrose, 1 mg/ml polyethylene glycol, 10 mg/ml Ficoll and 20% synthetic serum substitute. Following cryostorage for 10-14 d at -196 degrees C, the survival rate for oocytes vitrified with protocol A was 80.9%, whereas the post-thaw viability among protocol B oocytes was 80.6% (p > 0.005). Our results indicate that an ethylene glycol + dimethyl sulphoxide mixture (with or without polymer macromolecules) can be an effective cryoprotectant strategy for human oocyte vitrification; either approach can be employed without any observed compromise in post-warming survival and/or morphology.
To determine the feasibility and the safety of combined spinal/epidural and spinal anaesthetic techniques for primary caesarean section in case of preterm HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome.
A retrospective study was carried out in a tertiary centre including all patients who underwent primary caesarean section for HELLP syndrome. The immediate preoperative and the lowest thrombocyte count, the method of anaesthesia and eventual complications were recorded. Patients were categorised as having antepartum or postpartum HELLP syndrome.
A total number of 102 charts was reviewed. Mean gestational age was 30.6 weeks (SD 2.7, range 23-36 weeks). There were seven (6.9%) patients with postpartum HELLP and 95 with antepartum HELLP. In case of antepartum HELLP in 37 (36.3%) general anaesthesia was selected; in 53 (52.0%) combined spinal epidural anaesthesia and in 12 (11.8%) single dose spinal anaesthesia. Preoperative thrombocyte count was significantly higher (p < 0.01) in the combined spinal epidural group (113,000/mm3) while there was no difference between general (88,000/mm3) and spinal anaesthesia (95,000/mm3). There were no cases of epidural haematoma. Two patients received a combined spinal epidural although their immediate preoperative thrombocyte count was < 50,000/mm3.
Our data demonstrate that combined spinal/epidural is feasible and safe in selected cases of HELLP syndrome.
The authors study the correlation between sexual activity and parity in 106 pluriparous Sicilian women divided into 3 groups with parity, respectively, of 1 (57 cases), 2 (29 cases), and greater than or equal to 3 (20 cases). Sexual desire, frequency of coitus and orgasm, type of extracoital activity, preferred position during coitus, the partner who took the first initiative in sexual activity, and the contraceptive methods used were studied. The results show that in women of parity greater than or equal to 3 there is a significantly lower frequency of very frequent coitus, higher frequency of extravaginal sexual activity, and that the male more frequently took the first initiative in sexual intercourse.
To investigate whether serum levels of leukemia inhibitory factor (LIF), interleukin 10 (IL-10) and interleukin 11 (IL-11) are different in reference to the site of implantation.
Seventeen patients with laparoscopic diagnoses of tubal ectopic pregnancy (EP) and 19 patients with intrauterine pregnancy delivering healthy term neonates (IUP) were prospectively evaluated for LIF, IL-10 and IL-11 levels. The data were compared by using the Student's t-test, chi-square test, Kruskal-Wallis and the Mann-Whitney U test with Bonferroni's correction (p < 0.05) as appropriate.
A statistically significant difference was observed in serum LIF levels between the EP and IUP groups (p = 0.002). Ranges of LIF were 15-300 and 70-1200 ng/ml for the IUP and EP groups, respectively. There were no significant differences between groups in terms of IL-10 and IL-11 levels.
LIF, but not IL-10 or IL-11, levels may be increased in early tubal ectopic pregnancies when compared to normal intrauterine pregnancies.
The majority of ovarian masses in childhood and adolescence are non-epithelial in origin, with a predominance of germ cell tumors, while epithelial neoplasms comprise a small proportion of the total (approximately 15-20%). Mucinous cystadenomas in particular are only sporadically reported in this age group. We present a case of an ovarian mucinous cystadenoma with extended calcification in a premenarchal 11-year-old girl. Pediatric mucinous cystadenomas of the ovary may on rare occasions display extended calcification. Careful evaluation of the remaining pathological features of the tumor is needed in order to avoid misinterpreting this relatively non-specific finding as a feature of malignancy.
Congenital anomaly of the Müllerian duct system can result in various urogenital anomalies including uterus didelphys with blind hemivagina and ipsilateral renal agenesis. The diagnosis of this condition is usually made after menarche, but its rarity and variable clinical features may contribute to a diagnostic delay for years after menarche.
A 24-year-old woman presented to the emergency room of the Department of Obstetrics and Gynecology complaining of severe worsening lower abdominal pain, vomiting and pus-like vaginal discharge. Physical examination revealed acute abdomen with diffuse lower abdominal tenderness, rebound and muscular resistance. Cervical and vaginal observation was impossible because of the patient's discomfort. Bimanual gynecological examination showed high tenderness cervical motion. Transabdominal ultrasound scan was performed and the radiologist interpreted the ultrasonographic findings as existence of a pelvic mass with mixed echogenicity. The preoperative diagnosis was ruptured tubo-ovarian abscess and emergency laparotomy was performed. Free pus in the pelvis was found. Also, a double uterus with an elongated and inflammatory right fallopian tube with pus passing out of its fimbrial end was observed. Vaginal examination under general anesthesia revealed an obstructed right hemivagina with vaginal pus-like discharge from a small fistula hole on the septate vagina. The final diagnosis was uterus didelphys with unilateral imperforate right hemivagina and pyocolpos. Transvaginal resection of the vaginal septum was performed and a large amount of pus and blood was spilled out. Postoperatively, intravenous pyelography demonstrated agenesis of the right kidney.
We demonstrated the difficulty in making a correct diagnosis of this rare congenital anomaly of the female genital tract, especially after many years since menarche. This condition should be considered to prevent misdiagnosis or suboptimal treatment and decrease morbidity and unnecessary surgical procedures.
This was a retrospective clinical study of emergency hysterectomy performed between 1997 and 2007 at two tertiary hospitals to study incidence, indications and maternal mortality. We included all women who required emergency hysterectomy to control major postpartum hemorrhage after delivery, following a pregnancy of at least 24 weeks' gestation, regardless of the mode of delivery. There were 12 emergency hysterectomies, with a frequency of 0.0726% among 16,521 deliveries. Indications included uterine atony (4 cases), uterine rupture (3 cases), uterine retroversion (2 cases), abnormal placentation (2 cases) and amniotic fluid embolization (1 case). The result was two maternal deaths. Although emergency obstetric hysterectomy is a life saving operation, it is associated with high maternal mortality.
The aetiological factors associated with 1162 couples who attended a single infertility clinic and who were assessed according to a fixed protocol over an eight-year period were analysed retrospectively. Male problems accounted for 17 per cent, ovulation disorders 31 per cent, tubal factors were present in 18 per cent and idiopathic infertility was observed in 32 per cent. Single factor infertility was present in 58.8 per cent and multiple factors were present in 9.8 per cent of all cases. Although results may be biased by sub-specialty interests, only by continuous updating with reference to the most modern accepted methods of investigation can the likely demand for specialised infertility services and in vitro fertilisation be determined with accuracy.
Cord blood, because of its rich mix of fetal and adult hemoglobin, high platelet and WBC counts, and a plasma filled with cytokine and growth factors, as well as its hypo antigenic nature and altered metabolic profile, has all the potential of a real and safe alternative to adult blood transfusion. Our team's experience (from 1st April 1999 to 1st July 2005) with 123 units of placental umbilical cord whole blood (62 ml-154 ml mean 85 ml +/- 8.4 ml SD, median 82 ml, mean packed cell volume 48.8 +/- 4.2 SD, mean percent hemoglobin concentration 16.3 g/dl +/- 1.6 g/dl SD; after collection the blood was immediately preserved in a refrigerator and transfused within 72 hours of collection) collected after lower uterine cesarean section (LUCS), and the transfusion to 16 consenting HIV-positive patients (12 cases had full blown AIDS) with anemia and emaciation is presented here. On the basis of our preliminary experience of cord blood transfusion, we are of the opinion that umbilical cord whole blood transfusion is safe in HIV-positive patients. This blood has the potential to carry more oxygen than adult blood and it does not trigger any clinical, immunological or non-immunological reaction after its transfusion to an adult host with a HIV-positive status. Apart from the correction of anemia, there was also definite improvement in the energy and fatigue levels in individuals with HIV, i.e., physical functioning, a sense of well-being and weight gain from two to five pounds, within three to ten months of the commencement of transfusion. There was also an immediate rise in CD34 levels of peripheral blood in the HLA-randomized host after transfusion, without any clinical graft vs host reaction.
A case of heterotopic pregnancy after spontaneous conception with abortion of the intrauterine pregnancy and subsequent rupture of the ectopic pregnancy is presented. A 34-year-old woman at five weeks of gestation presented with a ruptured ectopic pregnancy after spontaneous abortion of an intrauterine pregnancy with mIU/ml beta3hCG as low as 125 mIU/ml. Close monitoring of betahCG and careful ultrasound examination together with patient consultation are extremely important in the management of heterotopic pregnancy, especially in cases of diagnostic uncertainness.
To evaluate the clinical utility of CA-125 in the diagnosis of endometriosis and to compare the sensitivity of the serum and the peritoneal test as indicators of disease, the quantitative determination of the antigen in serum and in peritoneal fluid was performed by the IRMA-mat "two-step method", a two-site immunoradiometric assay. A total of 28 women undergoing diagnostic or operative laparoscopy with endometriosis stage I-II (10 patients), endometriosis stage III-IV (8 patients) or other benign gynecological diseases (10 patients) were studied. The results were compared with a sample of 12 women with a normal pelvis (control group). CA-125 levels in the peritoneal fluid were higher than those found in the serum and were significantly elevated (p < 0.001) when compared with the control group, both in women with endometriosis stage I-II and stage III-IV. In the serum CA-125 levels increased only in advanced stages of endometriosis. Levels of CA-125 in peritoneal fluid seemed to be a more sensitive indicator of disease than the serum test (0.88 vs 0.44), especially in early stage endometriosis (0.80 vs 0.20) which tends to be overlooked by the CA-125 serum test.
Despite the widespread use of CA 125 for diagnostic and therapeutic evaluation of ovarian cancer function, the molecular nature of CA 125 is only poorly understood. It has been shown that CA 125 enhances the invasiveness of a benign endometriotic cell line in vitro. The invasiveness of cells is controlled by proteolytic activity, cell motility and cell adhesion. Therefore, we determined the influence of CA 125 on the cell adhesion of human carcinoma cell lines in vitro. In all tested human and mammalian cell lines (HECIA, AN3-CA, RL95-2, SK-OV-3, OAW-42, PA-1, HeLa, MCF7, T-47D, A-673, RT112, EJ28, EEC 145, CHO, MDBK, MDCK. LLC-PK1) the cell adhesion in vitro was significantly impaired by CA 125 in a time-dependent manner. Treatment of cells with trypsin diminished the effect of CA 125 on cell adhesion for two hours. By inhibition of protein synthesis with cycloheximide (2 microg/ml) the influence of trypsin on the anti-adhesive effect of CA 125 was significantly prolonged. The results suggest that the ovarian cancer antigen CA 125 influences cell adhesion in vitro.
We present the case of a patient with advanced endometriosis who presented with chronic pelvic pain, bilateral unruptured ovarian endometrioma, massive peritoneal implants and extremely elevated CA 125, and also elevated CA 15-3 levels. Laparoscopy revealed bilateral unruptured ovarian endometrioma and diffuse peritoneal endometriotic implants. Increased association of elevated levels of CA 125 and CA 15-3 is not so common in advanced endometriosis. The case was successfully treated with laparoscopy and combined low-dose oral contraceptive with one year of follow-up. To the best of our knowledge among the reported cases this is the highest CA 15-3 level ever reported with an extremely elevated CA 125 level.
Follow-up of a woman with a serum CA-125 level > 1000 U/mL where laparoscopy only found endometriosis.
Case report-- re-evaluation several years later.
Extensive clear-cell carcinoma of ovary with metastases leading to death.
This case suggests that bilateral oophorectomy should be performed in women not desiring any more children if the serum CA- 125 level is very high even if only endometriosis is found initially.
The need for the early detection of ovarian cancer continues to be one of the most important issues in women's health care. The three most extensively evaluated screening methods for ovarian cancer are pelvic examination, transvaginal ultrasonography, and serum CA-125 levels. The answers to questions such as should the levels of CA-125 be measured before bimanual pelvic examination or transvaginal ultrasonography or do abdominal examinations effect the levels of CA-125 are obscure. Fifty-four otherwise healthy female volunteers at the preovulatory phase of the menstrual cycle complaining of vaginal candidiasis were divided into 3 groups. Abdominal (group 1), bimanual pelvic (group 2), and transvaginal ultrasonography (group 3) examination was performed and serum CA-125 levels were evaluated prior to examination and 10 minutes, 6 hours, and 24 hours after the examination. As a result, serum CA-125 levels (U/ml) were found to be 8.13 +/- 4.76, 8.23 +/- 5.05, 8.32 +/- 4.88, and 8.33 +/- 4.94 in the group of abdominal examination, respectively, 8.23 +/- 4.89, 8.45 +/- 5.15, 8.77 +/- 4.96, and 8.79 +/- 5.50 in the group of bimanual pelvic examination, respectively, and 8.19 +/- 4.56, 8.30 +/- 5.10, 8.81 +/- 5.56, and 8.88 +/- 5.71 in the group of transvaginal ultrasonography, respectively. The serum CA-125 levels detected prior to examinations were statistically insignificant when compared with the results obtained at 10 minutes, 6 hours, and 24 hours later in all three groups. We concluded that physical examination, either abdominal or pelvic, and transvaginal ultrasonography do not change the serum levels of CA-125.
To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center.
This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively.
Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%).
HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.
To explore effective methods in diagnosing and treating cesarean scar pregnancy (CSP) after cesarean section.
The clinical data of 13 cases with CSP who were admitted to the present hospital from October 2009 to February 2012 were retrospectively analyzed.
The agreement diagnostic rate was 92.3% (12/13). On the basis of transvaginal color Doppler ultrasonography 12 patients had medical therapy combined with uterine artery embolization (UAE) and curettage was successfully performed. One patient was diagnosed through an emergency setting due to symptomatology.
Early accurate diagnosis of CSP is the key to perform proper and successful treatment.
To determine the percentage of males with a low hypoosmotic swelling (HOS) test score in couples having in vitro fertilization-embryo transfer (IVF-ET) where the male partner had normal motile densities and no antisperm antibodies.
The results were also analyzed according to the percentage of HOS scores < 50% when morphology using strict criteria was < or = 4% or > 4%. A retrospective review was performed.
There were 250 subnormal HOS scores out of 1993 otherwise normal semen specimens.
12.5% of couples would have had conventional oocyte inseminations rather than ICSI if the HOS test had not been not performed (it is rarely performed by other IVF centers). Without ICSI expected live delivered pregnancy rates would be close to zero for males with low HOS tests < 50%. Intracytoplasmic sperm injection allows pregnancy rates almost as good as completely normal sperm.
To develop a nomogram for estimating nasal bone length (NBL) at 11(+0) - 13(+6) weeks of gestation in 554 consecutive cases and to determine the value of NBL measurement in screening for chromosomal abnormalities.
NBL and crown-rump length (CRL) were examined in 554 fetuses at 11(+0) - 13(+6) weeks' gestation. A nomogram for NBL was developed with data from 479 healthy fetuses in which fetal profile examination was possible. Reference values, including percentiles, weie calculated for each gestational age.
A linear correlation was noted between CRL and NBL in healthy fetuses at 11(+0) - 11(+6), 12(+0) - 12(+6) and 13(+0) - 13(+6) weeks of gestation. Mean NBL was 2.18 +/- 0.53 mm, 2.46 +/- 0.45 mm, and 2.91 +/- 0.55 mm in healthy fetuses, for these time frames, respectively. NBL increased significantly with CRL from respective means of 2.26 +/- 0.43, 2.60 +/- 0.48, 2.77 +/- 0.43, and 3.16 +/- 0.52 mm at 45 - 54.9, 55 - 64.9, 65 +/- 74.9, and 75 - 84 mm.
The authors developed a NBL nomogram with data from normal, healthy Turkish fetuses at 11(+0) - 13(+6) weeks of gestation. These reference ranges may prove useful in prenatal screening and diagnosis of syndromes known to be associated with nasal hypoplasia.
Radioactive iodine has been used effectively in the diagnosis and treatment of thyroid diseases. Since radiation is delivered to the whole body, including the ovaries, there is reasonable concern as to whether there is a possibility of mutagenic effect on germ cells.
A 33-year-old woman with a differentiated papillary carcinoma. (T2N0M0), underwent radiotherapy three weeks after surgery and one year afterwards she became pregnant. At the 38th week of gestation she delivered vaginally a healthy female neonate weighing 3100 g. The child at the age of five years is healthy with no signs of malignancy or other disease.
Washout of 131I of the whole body takes place in a few days. Nevertheless, most guidelines recommend avoiding pregnancy for four to six or even 12 months after RAI treatment or scanning. As reported in our case a normal uncomplicated pregnancy can follow an operative and complementary treatment of thyroid cancer.
All ovarian teratomas observed from 1979 to 1989 in the Institute of Pathology University of Padua are revised. Mature and immature teratomas are analyzed separately because of their different prognoses.
13q-syndrome is a rare chromosomal disorder caused by partial deletion of the long arm of chromosome 13 with variable phenotypic presentation. Further sonographic features involve fetal growth restriction, bradycardia, encephalocele, facial dysmorphism and upper extremity deformity. We report a case of 13q-syndrome presenting as increased nuchal translucency diagnosed by chromosome studies and confirmed by array comparative genomic hybridization (CGH) analysis in the first trimester of pregnancy. Pregnancy was terminated at 14 weeks' gestation. The parents did not give consent for a postmortem examination. Furthermore we performed a systematic review of the international literature on previous cases of 13q-syndrome diagnosed prenatally. Our case emphasizes the importance of a detailed 11-14 week ultrasound assessment in diagnosing fetal chromosomal aberrations in combination with the modern aspects of array CGH, thus providing more precise and rapid prenatal diagnosis.
The Authors analyse the functional areas (cortical, paracortical, germinal center, medullary, histiocytosis of the sinuses) of regional lymph nodes in women having uterine carcinoma and previously treated with Thymostimuline, and who were operated on respectively 8 and 14 days after inoculation. They also evaluate the degree of significance when compared with a control group treated locally with a physiological solution. The number of lymph nodes examined is at least 5, and the stereological analysis was carried out with the use of a grid: 200 points, actual area 200 cm2, effective area at the level of the preparation 0.32 mm2 (250 X). The Authors examine the results obtained after 8 days' action by Thymostimuline, and, after 14 days, the difference between the 8-day-after and the 14-day-after administration results, and those between the cervical and the endometrial. 4 women with uterine cancer (Stages I and II) and treated with the same doses of physiological saline solution were used as controls.
During the last 15-year period in our laboratory, 14 cases of malignant change of endometriosis were diagnosed in women 37-70 years of age. Seven cases were adenocarcinomas, one case was an adenosarcoma and six cases presented the morphology of endometrial stromal sarcoma. Eleven cases developed in various sites of the genital system (5/11 in the ovaries, 3/11 in the uterus 2/11 in the vagina, 1/11 in the tubal wall) and three cases in extragenital sites (1/3 in the omentum, 1/3 in the pelvis, 1/3 in the colon). Immunohistochemical investigation for the expression of cytokeratines, vimentin, hormonal receptors, E-cadherin, desmine and smooth muscle actin was performed by a streptavidin-biotin method. The immunopathology profile and follow-up results after therapy are presented.
A case of bilateral cleft lip and palate associated with increased fetal nuchal translucency detected at 14 weeks of gestation in a cocaine abusing pregnant woman is presented. There were no other associated structural or chromosomal abnormalities. We propose that systematic examination in both the sagittal and parasagittal plane of the fetal profile and recognition of the characteristic ultrasound appearance of a premaxillary protruding echogenic mass should make detection of this type of cleft relatively easy at the moment of the first trimester scan. First trimester diagnosis of cleft lip and palate can facilitate the parental decision-making process on continuing or terminating the pregnancy and should open the perspective of fetal surgery.
In the year 1902, the first successful experimental organ transplant, i.e., an autotransplant of a dog's kidney from its normal position to the vessels of the neck, which resulted in some urine flow, was performed in the Vienna Physiology Institute under the direction of Hofrath Exner by Dr. Emerich Ullman (1861-1937). Since then, the art of transplant surgery has come a long way in establishing itself as an important discipline with the support disciplines of immunology, molecular biology, etc., for the restoration of a failing organ. Today there is a major discrepancy in the demand and supply of organ grafts. The aim of the present study is to see whether fetal organ and tissue, with its intrinsic advantages of hypo-antigenicity, can survive in a HLA and sex-randomized host in a surgically prepared vascular subcutaneous axillary fold, without any immunosuppressive support. We have earlier reported two cases of fetal thymic transplant, collected from consenting mothers undergoing hysterotomy and ligation.
Fourteen cases were recruited for the present study after thorough informed consent and approval by the Ethical Committee of the Project. Of these, five patients were suffering from advanced cancer, three from diabetic gangrene, three from ischaemic heart disease and three from rheumatoid arthritis, liver abscess and disc prolapse. The ages of the patients varied from 39 to 82 years. Six fetal thymuses, three fetal liver tissues, three fetal cardiac tissues, one fetal pancreas and one fetal lung tissue were transplanted. All the fetuses were dissected and the selected tissues/organs were transplanted within one to three minutes after collecting them from the consenting mothers undergoing hysterotomy and ligation. The fetal tissue graft was placed in a surgically prepared subcutaneous vascular axillary fold, 2x1 cm, under local anaesthesia in the consenting adult recipient. Sequential Hb, Tc, Dc, ESR were done to see the impact of the transplant on the host system. After one month, the transplanted fetal tissue was taken out by an elliptical incision and the tissue was processed for histological staining.
All the 14 patients tolerated the transplant procedure well. There was no fever, intractable pain or any other specific serious side-effect justifying removal of the transplant earlier. There was no discharge from the incision site and the healing and scar were by and large normal. There was no unusual leucocytosis or lymphocytosis. The serial histological study did not suggest features of transplant rejection.
Pregnancy and neoplasm are two outstanding examples of natural tolerance to homograft. In both cases, blocking antibody has an important role in the phenomenon of immunotolerance. From our experiments mentioned above transplantation and our earlier reported studies, we believe that the hypo-antigenic fetal tissue has distinct advantages over adult tissue for transplant purposes.
Pelvic infections represent the most feared complications associated with vaginal and abdominal hysterectomy. In the present paper we show result of a prospective randomized clinical trial carried out to study different morbidities (F.M. febrile morbidity, U.T.I. urinary tract infections, P.C. pelvic cellulitis, P.A. pelvic abscess, W.I. wound infection) in a sample of 155 patients undergoing vaginal or abdominal hysterectomy for non malignant disease, divided into three groups. group C, treated with 2 g cefoxitin i.v. in the preoperative period; group C+T, the same treatment with the addition of T tube suction drainage; group T, with only the T tube suction drainage. A statistical analysis of the sample showed the homogeneity of each group, while the study of the morbidities showed a statistical significant difference for W.I. between the groups treated with antibiotic and the T group (p less than .001). For all the other morbidities, no statistically significant differences were found between the groups, demonstrating that all three methods are considerably efficient in reducing postoperative morbidity in hysterectomy.
40 patients, pregnant clinically from 12 to 24 weeks in whom pregnancy termination for medical or medicosocial reasons was indicated, were given 250 micrograms Prostin 15M (15 methyl prostaglandin F 2 alpha, Upjohn) intramuscularly every three hours in total dose from 500 micrograms to 3000 micrograms. The Committee for Medical Ethics of the Committee for Medical and Social Security of SRS approved the study to be performed at the University Gynecological Hospital of Ljubljana using the drug and following the protocol of Upjohn (Tehnoservis). 36 patients (90%) aborted within 48 hours after the first injection (mean interval was 15.43 hours). In three out of 40 patients (7.5%) the abortion was complete, in 34 (85.0%) it was incomplete. In two patients, dilatation of cervical canal was complete, but the expected abortion did not take place. One patient aborted in 52 hours and 10 minutes. Only in a single case induction of abortion was completely unsuccessful. The drug is considered effective for induction of abortion in the second trimester of pregnancy.
A rare case report of heterotopic pregnancy, ruptured in the 15th week of gestation is presented. The intrauterine pregnancy continued after the laparotomy and removal of the extrauterine fetus and ended with a normal delivery in the 39th week.
Labor was induced via intravenous infusion of 16-phenoxy-prostaglandin-E2-methylsulphonylamide in 13 cases of missed abortion and 19 cases of intrauterine fetal death. In all cases Bishop score was less than 4. Delivery occurred within 24 hours in all cases, with a minimal frequency of side effects (six cases of erythema above the incannulated vein and 1 case of diarrhea). The interval between the beginning of the infusion and delivery was 9.42 minutes. Uterine curettage was performed in 9 cases.
Unwanted pregnancies and the subsequent induced abortions are common problems of our youths in modern Greece. The aim of this study was to recognize the risk factors of the problem in an effort to find the best possible solution out of this social dead end.
We interviewed 1,320 young female individuals and analyzed their answers using statistical analysis.
Several useful conclusions were reached concerning the forces that are involved in unwanted pregnancy/induced abortions.
We have tried to underline the strategy to combat the problem.
Sexual education and the proper use of contraception remain the essential tools in this effort.
Puntaction hybridization method was used to determine the incidence of the human papilloma virus infection in cases with the squamous cell cancer of the vulva and cervix uteri. The presence of sequences of DNA of the HPV genotype and 16 was found in 74.2% of cases, which points to a suspicion for the involvement of the above viruses in etiology of cervix uteri cancer, as well as vulva cancer.
Trisomy 16 is a very frequent autosomal anomaly accounting for about 2% of first trimester abortions. In most pregnancies the chromosomal genome found in the fetus is also present in the placenta. Confined placental mosaicism is frequently detected in the placental region along with a structurally normal fetus.
We present the case of a 39-year-old primigravida with confined placental mosaicism diagnosed with chorionic villus sampling. Amniocentesis showed a normal karyotype (46, XX). Detailed scanning revealed no structural fetal anomalies, but severe oligohydramnios.
Diagnosis of trisomy 16 does not necessarily mean that the newborn has anatomical abnormalities.
The aim of this retrospective study was to consider the problem of grand multiparity in our female population to evaluate if grand multiparity represents a real risk factor for pregnancy, delivery and fetal well-being. From 1981 to 1989 the Gynaecology and Obstetrics Institute of Turin University together with St. Anna Hospital of Turin carried out a retrospective study on pregnancy course, delivery and fetal status in 168 women who had had four or more pregnancies and in 5320 multiparous women who had parity < 4. We analyzed the parity distribution in the different ages with the aid of the registry office and by consulting patient's obstetric clinical history. We evaluated the incidence of gestational complications in the multiparous group. Finally we studied the delivery modality and perinatal mortality in 72,907 births from 1981 to 1989.
The research here reported concerns 9 hirsute women, four of them with PCO and five with idiopathic hirsutism, who underwent treatment with spironolactone. 4 non hirsute hypertensive cases served as control. For one year hair growth, testosterone, 17 Ks, estradiol and gonadotropins behaviours were studied in all of the patients. Results clearly show that the peripherical response (the hair) to the therapy is only just sufficient, and corresponds to a good reduction of the androgenic hormones in blood. However, there is also an LH gonadotropin secretion reduction which is statistically scarcely significant. If the therapeutic response of hair were good, fetal risk could be prevented with safe and contemporaneous contraception. However, since the response is scarcely sufficient, we do not think this therapy is more advisable than other ones.
This study was designed to investigate the effects of 17 beta-estradiol on prostanoid formation from exogenous arachidonic acid in homogenates of human umbilical cord vessels. The veins produced more prostanoids than the arteries and predominantly 6-keto-PGF1 alpha. 17 beta-estradiol had no effect on the rate of production of prostanoids in either vessels. Thus, at least in our in vitro system, the regulation of the vascular tone by prostanoids seems not to be altered by the addition of 17 beta-estradiol.
Premature ovarian failure (POF) in a healthy adolescent is a rare event. It is diagnosed by the presence of amenorrhea, hypoestrogenism, and elevated follicle-stimulating hormone (FSH) levels before the age of 40.
The patient presented with amenorrhoea at 17 years after identifying a change from her regular to irregular and metrorrhagic cycles. No positive medical history was noted regarding smoking, chemotherapy, radiation or autoimmune diseases and the physical examination was normal. Her family history revealed that both her maternal aunt and grandmother were affected by POF, but the karyotype test was normal and the FMR1 screening premutation test was negative. The patient underwent an ovarian biopsy which revealed the absence of functional follicles. She began a replacement therapy with estroprogestogens and she was informed about the most successful means to start a family, including adoption and oocyte donation.
POF is a heterogeneous, multifactorial, and poorly understood condition that involves medical concerns, psychological sphere, and sexuality of the affected patients. Management should be directed at symptoms resolution, bone protection, and psychosocial support for women facing this unexpected and devastating diagnosis.
The Authors refer on the validity of echoscopic examination and hCG, progesterone and 17-beta estradiol values in the prognosis of threatened abortion during the first trimester of pregnancy in 62 patients. The echoscopic examination allowed a prognosis to be made in accordance with the clinical evolution of threatened abortion in 90% of the cases; the plasma levels of hCG and progesterone in 87% of the cases; 17-beta estradiol in 83% of the cases. The Authors conclude that the simultaneous assay of hCG, progesterone and 17-beta estradiol plasma levels does not improve the prognostic validity of echoscopy but, in some cases, can provide essential details on the etiology of threatened abortion itself.
The effect was investigated of endothelin 1 and 17 beta-estradiol on prostacyclin and thromboxane A2 production (determined as the stable metabolites 6-keto-PGF1 alpha and thromboxane B2, respectively) in endothelial cell cultures obtained from veins of human umbilical cord. There was a statistically significant increase of 6-keto-PGF1 alpha production with endothelin 1 at concentrations of 10(-8) and 10(-9) M [9.5 +/- 1.1% and 7.2 +/- 0.9%, (mean +/- SD, n = 5), respectively] compared to basal production. In contrast, 17 beta-estradiol alone (10(-6) and 10(-8) M) had no effect. In the presence of 17 beta-estradiol (10(-8) M) the stimulating effect of endothelin 1 (10(-8) and 10(-9) M) on 6-keto-PGF1 alpha production was further enhanced to 60.0 +/- 22.5% and 39.5 +/- 22.1%, respectively, compared to basal values. With respect to thromboxane B2, no change in its production was observed by the addition of endothelin 1 and 17 beta-estradiol, alone or in combination in the concentrations mentioned above. These results indicate that 17 beta-estradiol potentiates the effects of endothelin 1 on prostacyclin production in human endothelial cells.
The use of luteal phase support has been demonstrated in patients undergoing an IVF/ET procedure. This study was designed to compare the absorption and the efficacy of two different luteal supports: 17-alpha-hydroxyprogesterone caproate (Lentogest, AMSA, Italy) and natural Progesterone (Prontogest, AMSA, Italy). A total of 80 patients received luteal supplementation with 50 mg of natural P/day intramuscularly, until beta-hCG evaluation. Then, in case of positive beta-hCG, patients were randomly divided into two groups (A and B) in order to compare two different protocols: Group A, 17-OHPc (341 mg once a week) and Group B, natural P (50 mg/day) both intramuscularly and extended for 10-12 weeks. Our study showed that the treatment with 17-OHPc results in a higher percentage of pregnancy rate compared to natural P, but the differences are not statistically significant. Thus, we emphasize that 17-OHPc preparation for better acceptance appears to be the most suitable and comfortable method for luteal phase support.