A Liberis

Turner's syndrome and pregnancy: has the 45,X/47,XXX mosaicism a different prognosis? Own clinical experience and literature review

Turners syndrome is characterized by an ovarian failure which occurs in most cases before puberty and leads to infertility. In less than 10% of women with Turner syndrome, puberty may occur and spontaneous pregnancies is possible but with a high risk of fetal loss, chromosomal and congenital abnormalities. We present the case of a 33-year-old woman with a mosaic Turners syndrome karyotype 45,X/47,XXX who conceived spontaneously and had two successful pregnancies. Short stature was the only manifestation of Turners syndrome. In the present report, we reviewed the available literature on the fertility of women with Turners syndrome and the phenotypic effects of mosaicism for a 47,XXX cell line in Turners syndrome.

The contribution of catumaxomab in the treatment of malignant ascites in patients with ovarian cancer: a review of the literature

The approval of the first specific drug catumaxomab for the treatment of malignant ascites is the subject of this review. This trifunctional antibody is known to kill EpCAM-positive tumor cells and therefore attacks the primary cause of malignant ascites formation in the peritoneal cavity. Until today catumaxomab is the only EpCam-targeted antibody approved by the European Medicines Agency. Ovarian cancer is caused by epithelial tumors cells which overexpress epithelial cell adhesion molecule (EpCAM). The existing literature concerning the use of catumaxomab for the treatment of malignant ascites associated with ovarian cancer until today is reported in this article. It is very encouraging that different prospective studies from diverse scientific teams recently presented positive results concerning the efficacy and the safety of catumaxomab in the treatment of malignant ascites in patients with ovarian cancer. A case of a patient with ovarian cancer FIGO IIIc is also referred in this article. A complete remission and stable disease was found after 4 i.p. infusions of catumaxomab.

Transvaginal aspiration of ovarian cysts: Our experience over 121 cases

Abstract We performed an evaluation of ultrasound-guided transvaginal aspiration of ovarian cysts as a viable alternative to surgery in 104 reproductive and 17 postmenopausal women. One-hundred and twenty-one patients with a simple >4 cm diameter ovarian cyst, with a benign appearance on ultrasound as well as on clinical and blood examination, underwent transvaginal fine needle aspiration of the cyst under ultrasonographic control. One-hundred and four patients were of reproductive age and 12 were postmenopausal. Sixty women who were of reproductive age and in which OCP treatment was not contraindicated followed a six-month therapy with oral contraceptives after the intervention. In the group of patients of reproductive age under OCP treatment the cyst persisted in nine of the 60 women (recurrence rate 15%). In the other group of patients of reproductive age,under no OCP treatment, the recurrence rate was 47% (21 of the 44 women). In the group of postmenopausal patients, the cyst persisted in ten out of 17 cases (recurrence rate 58,9%). Transvaginal aspiration of ovarian cysts is a reliable alternative to surgery with many advantages such as excellent tolerance, low risk and cost of complications and recurrence. The OCP treatment after aspiration seems to increase the success rate of expectant management.

The contribution of hysteroscopy to the detection malignancy in symptomatic postmenopausal women

Abstract Hysteroscopic evaluation of endometrial cavity is widely used in cases of abnormal uterine bleeding. The aim of the present study is to compare the hysteroscopic and histological findings in women suffering from postmenopausal bleeding. Between 1990 and 2009, 425 women aged 47–83 years were included in the study. None of the women had received hormonal therapy or had any malignancy in the past. All women underwent diagnostic hysteroscopy and histologic sampling of the endometrial cavity. Hysteroscopy was successfully completed in 423 women and was suggestive of malignant lesions in 23 cases, which were confirmed histologically. The hysteroscopic findings in three cases were suggestive of atrophic endometrium, atypical hyperplasia and endometrial carcinoma, and the histologic diagnosis confirmed endometrial carcinoma (two cases) and one uterine sarcoma. Hysteroscopy proves to be a safe and effective technique in the diagnosis and management of abnormal uterine bleeding.

Hysteroscopy and endometrial cancer. Diagnosis and influence on prognosis

Diagnostic hysteroscopy is a simple procedure that can provide a good visualization of the whole uterine cavity without cervical dilation and usually without anesthesia. It has been proposed as an office method for diagnosis of endometrial disorders, including cancer. Hysteroscopy, especially combined with endometrial biopsy, has high diagnostic accuracy. However, concerns have been raised about the potential for hysteroscopy to flush malignant endometrial cells into the peritoneal cavity through the fallopian tubes and to cause dissemination of malignant cells into the abdominal cavity through the fallopian tubes from uteri containing endometrial carcinoma. Moreover, some controversy also remains about the functional viability of these cells and their potential to cause metastases.

Genotoxic effect of tocolytic drug ritodrine in combination with smoking during pregnancy.

Abstract Objective: Tocolytic drugs are used widely in order to prevent preterm birth. Ritodrine, is the only food and drug administration (FDA) approved drug for tocolytic use. We estimated the cytogenetic effect of ritodrine administered as maternal therapy, alone or in combination with smoking, in women and their neonates. Methods: Lymphocyte and fibroblasts cultures were evaluated and three indices were analyzed; sister chromatid exchanges (SCEs), proliferation rate index (PRI) and mitotic index (MI) as well as average generation time (AGT) and population doubling time (PDT). Campothacin (CPT-11) was used as a positive control. Results: Administration of ritodrine up to a month revealed significant reduction of SCEs/cell in neonates in the presence or absence of the mutagenic agent. A statistical significant increase on SCEs, for mothers and neonates, was noticed in neonate’s lymphocytes when tocolytic therapy was over a month. Ritodrine revealed a cytoprotective action against smoking when the two factors were combined, but the synergistic action of ritodrine with smoking increased genotoxicity, cytostaticity and cytotoxicity of neonates after long administration (1–3 months). Conclusions: The time-depended genotoxic, cytostatic and cytotoxic action of ritodrine alone or in combination with smoking suggests that its administration should not exceed the time period of a month.

Differential Diagnosis of Ectopic Pregnancy - Morbidity and Mortality

The term ectopic pregnancy refers to a gestation in which the fertilized ovum implants on any tissue other than the endometrial membrane lining the uterine cavity. Fig 1 presents the various types of ectopic pregnancy and their relative frequencies The classic clinical symptoms of ectopic pregnancy are pelvic pain, amenorrhea, and vaginal bleeding , spotting (40-50%). However, only 50% of patients present typical symptomatology. Patients may present with other symptoms common to early pregnancy, including nausea (frequently after rupture), breast fullness, fatigue, abdominal pain, heavy cramping, shoulder pain, and recent dyspareunia . Physical findings during examination should be pelvic unilateral tenderness, especially on movement of cervix (75%), enlarged uterus or palpable adnexal mass; crepitant mass on one side or in culde-sac (50%). Approximately 20% of patients with ectopic pregnancies are hemodynamically compromised at initial presentation, which is highly suggestive of rupture. Body temperature ranges from 37.2 to 37.8 0C while the pulse is variable: normal before but rapid after rupture. Today, using modern diagnostic techniques, most ectopic pregnancies may be diagnosed prior to rupturing [1]. Diagnosis of ectopic pregnancy has been greatly improved by the advent of rapid serum beta-human chorionic gonadotropin (beta-HCG) tests and then the widespread adoption of transvaginal pelvic ultrasonography (TVUS) [2]. Serum beta-HCG levels can definitively rule out pregnancy if negative, although there have been case reports of pathology-proven ruptured ectopic pregnancy and hemorrhagic shock despite an undetectable serum beta-HCG [3]. In the early stages of a normal intrauterine pregnancy (IUP), the serum beta-HCG rises along a well-defined curve. Therefore, serial beta-HCG tests can be useful for determining the ultimate location of a pregnancy of unknown location. The lower limit of normal rise in beta-HCG (using a 99% confidence interval) is 53% in 2 days [4]. Patients with a beta-HCG level that falls more than 50% in 2