Cheng-Hui Yang

Leptin Affects Pregnancy Outcome of In Vitro Fertilization and Steroidogenesis of Human Granulosa Cells

Purpose: This study was to examine the serum leptin levels in the prediction of pregnancy outcomes in women receiving ovarian hyperstimulation. Effect of leptin on the steroidogenesis was evaluated for granulosa cell (GC) culture in vitro. Method: Serum levels of leptin and estradiol were measured on Day 2, the time of hCG administration and oocyte retrieval in 50 women undergoing long-course GnRH agonist ovarian hyperstimulation. The production of estrogen and progesterone in granulosa cell culture were detected after administration of leptin at the absence or presence of FSH 1 mIU. Results: Leptin levels at the time of hCG injection were significantly lower in the pregnant women than in those without pregnancy. Estradiol concentrations were not correlated with leptin levels during the time of hCG injection and oocyte retrieval. High leptin concentration suppressed both basal estradiol and progesterone productions in GC. Leptin in high doses suppressed estradiol production, but did not alter progesterone production of GC in the presence of FSH. Conclusions: Serum leptin levels may be predictive of IVF pregnancy outcome with the effect on intraovarian progesterone/estradiol ratio during the follicular phase. Significantly low serum leptin levels were noted in the pregnant women than in the nonpregnant women.

Bladder neck circulation by Doppler ultrasonography in postmenopausal women with urinary stress incontinence

OBJECTIVE To investigate the effect of hormone replacement therapy (HRT) on bladder neck circulation in postmenopausal women with genuine urinary stress incontinence (USI). METHODS A total of 227 women were enrolled in the study, including 114 postmenopausal women with USI (n = 57) or without USI (n = 57) and 113 premenopausal women with USI (n = 55) or without USI (n = 58). The bladder neck circulation was measured in 31 postmenopausal women with USI and in 12 without USI, all of whom received 0.625 mg conjugated equine estrogen plus 5 mg medroxyprogesterone acetate daily for 6 months. Bladder neck blood flow data detected by perineal color Doppler ultrasonography and weekly urinary diary data were collected before HRT and then 3 and 6 months after beginning HRT. Two‐way analysis of variance and repeated measures of variance were used for statistical analysis. Power analysis was done by a two‐sided test with a significance level at .05. RESULTS The pulsatility index (PI) was significantly higher in the postmenopausal than in the premenopausal women. The postmenopausal women with USI had the highest PI level. The presence of USI did not change the PI values in the premenopausal women. After 3 months of HRT, the PI levels decreased significantly (P < .001) in the postmenopausal women with USI. The subjective improvement of USI appeared after 3 months of HRT. CONCLUSION The blood flow around the bladder neck in women can be measured by perineal color Doppler ultrasonography. Hormone replacement therapy increases the blood flow around the bladder neck in postmenopausal women with USI. The clinical improvement of USI can be seen with HRT after 3 months.

Effect of hormone replacement therapy on uterine fibroids in postmenopausal women—a 3-year study

OBJECTIVE The aim of this prospective 3-year clinical study was to examine the effect of hormone replacement therapy (HRT) on uterine fibroid growth among postmenopausal women. METHODS Thirty-seven postmenopausal women with uterine solitary fibroids were recruited randomly for HRT in a 3-year program. All participants received 0.625 mg conjugated equine estrogen (CEE) and 5 mg medroxyprogesterone (MPA) daily. Fibroid volume was measured by transvaginal ultrasonography at baseline and then at 12-month intervals for 3 times. Clinically, significant fibroid growth was defined as an increase in volume of more than 25% compared with baseline. Also, 35 postmenopausal women with uterine fibroid were studied as control who did not receive HRT during the study period. RESULTS Fibroid volume had increased significantly after 1 year both in HRT users and non-users. These increases continued to the second year significantly in HRT users but not in non-users. However, the volumes declined significantly at the third year to similar levels as those measured at baseline in control. In HRT users, fibroid volume though significantly increased at the third year (vs. baseline) but declined insignificantly in comparison with the second year. Clinically, at end of the third year study, one of 34 and three of 34 women increased fibroid volume over 25% compared with baseline in HRT non-users and users, respectively. CONCLUSIONS HRT does increase uterine fibroid volume statistically. However, its effect appears in the first 2 years of use. The increased fibroid volume begins to decline at the third year both in HRT users and non-users. Clinically, the increased effect of HRT on uterine fibroid of postmenopausal women should be not over-emphasized at least for 3 years of usage.

Laparoscopically Assisted Vaginal Hysterectomy versus Total Abdominal Hysterectomy: A Study of 100 Cases on Light-Endorsed Transvaginal Section

The objective of this study was to compare the results of a modified laparoscopically assisted vaginal hysterectomy (LAVH) procedure, using light-endorsed transvaginal section by two puncture trocars, with those of total abdominal hysterectomy (TAH) in a prospective, randomized, short-term study. A new, modified LAVH technique using Endo GIA stapler and two puncture trocars was established. For the laparoscopic phase, each adnexum was dissected, and the vesicouterine junction was identified clearly with the laparoscopic light from the vaginal side. Vaginal-phase surgery was performed as usual. Two hundred patients scheduled for abdominal hysterectomy were randomized to either LAVH (n = 100) or TAH (n = 100). Duration of hospitalization, time of surgery, dose of analgesics, and rates of complications were significantly lower in the LAVH group (p < 0.001). The average operating time was 77 ± 30 min for LAVH and 102 ± 18 min for TAH. The duration of hospitalization was 3.2 ± 0.7 days for LAVH and 5.5 ± 1.3 days for TAH. There were three complications in the LAVH group and 15 in the TAH group. Postoperative meperidine requirements (1.2 vs. 3.7 ampoules, 1 ampoule = 50 mg) were significantly fewer in the LAVH group. Regarding the training time, the mean operating time in the first 20 cases was 98 min, and in the last 20 cases it was 70.9 min. As compared with TAH and other modified LAVH procedures reported previously, the present technique is easy to learn and timesaving with fewer complications.

MULTILOBULAR CYST AS ENDOSALPINGIOSIS OF UTERINE SEROSA: A CASE REPORT

A case of endosalpingiosis presented as a multilobular cyst on sonography. The tentative clinical diagnosis was an ovarian tumor; however, laparotomy revealed a degenerative cyst of the uterine myoma with a stalk connecting to the uterus. Histopathologically, it showed characteristics of endosalpingiosis. To our knowledge, such a multilobular cyst of endosalpingiosis originating solely from the uterine serosa has not been reported.

Cyclooxygenase-2 expression in the endometrium at the end of 2 years’ continuous combined hormone replacement therapy

OBJECTIVE To evaluate the change of endometrial histology and the expression of cyclooxygenase-2 (Cox-2) in the endometrium after continuous combined hormone replacement therapy (HRT). METHODS Forty-five postmenopausal women were recruited. All participants received 0.625 mg conjugated equine estrogen (CEE) and 2.5 mg medroxyprogesterone (MPA) daily for 2 years. Endometrial biopsy was performed twice, before medication (baseline) and after 2 years of HRT, respectively. Immunohistochemistry was used to detect the presence of Cox-2 expression. RESULTS More atrophic and weak secretory features of endometrium were noted after the 2-year HRT. Endometrial hyperplasia and carcinoma were not found and immunohistochemistry results revealed that Cox-2 was not expressed in the endometrium. CONCLUSION Cox-2, known to play an important role in the tumorigenesis of cancer, was not stained in endometrium tissue after hormonal induction and more endometrium atrophy was noted after the 2-year HRT. From the results, it is noted that continuous combined HRT may be a relatively safe and appropriate regimen for long-term use in postmenopausal women.

Postmortem Cesarean Section Following Maternal Burn

Objective: Postmortem cesarean section of a living infant is very rare. There are few cases of surviving infants delivered more than 15 min after maternal cardiopulmonary arrest. Timing of the operation is critical for the infant. Case Report(s): We report on a case of a living male infant delivered by a 37-year-old primigravida woman, at approximately 39-weeks’ gestation, who died after having been severely burned in an accident. A postmortem cesarean section was performed 55 min after the accident and probably more than 28 min after maternal cardiopulmonary arrest. The baby was kept alive with ventilatory assistances but eventually died 5 months later. Conclusion(s): To the best of our knowledge, the present case might show the longest interval between maternal death and infant birth of more than 28 min. Although this fetus had a poor outcome, obstetricians should consider a cesarean section in any pregnant woman during the third trimester with acute cardiopulmonary arrest because of the potential to rescue a normal infant.