Dimitrios Vavilis

Factor V Leiden and prothrombin G20210A mutations in pregnancies with adverse outcome

Background: Inherited thrombophilia has been associated with obstetric complications through mechanisms that are not yet fully elucidated. The aim of this study was to investigate the relationship between specific obstetric adverse outcomes and factor V Leiden and prothrombin G20210A mutations. Methods: Forty-five women with adverse pregnancy outcome defined as severe pre-eclampsia, abruptio placentae, intrauterine growth restriction and stillbirth, were tested for factor V Leiden and prothrombin G20210A mutations. The control group comprised 100 women with at least one normal pregnancy and no history of thrombosis. Results: Overall, 13 women with one or more of the above-mentioned pregnancy complications (28%) had either thrombophilic mutation, as compared with six in the control group (6%) (p < 0.001, odds ratio (OR) 6.1; 95% confidence interval (CI) 1.9-20). The factor V Leiden mutation was detected in ten of the women with complicated pregnancies (22%) and in four of the controls (4%) (p < 0.001, OR 6.6; 95% CI 1.7-27.2). The prothrombin G20210A mutation was detected in three women in the group with complications (6%) and in two of the controls (2%) (p = 0.17, OR 3.4; 95% CI 0.4-30.5). Compared to controls, the prevalence of the factor V Leiden mutation was significantly higher in the subgroups of severe pre-eclampsia, abruptio placentae and fetal growth restriction. The prevalence of the prothrombin G20210A mutation does not appear to be significantly different from that in the controls in any of the groups studied. Conclusions: Our data suggest that inherited thrombophilia, and specifically the factor V Leiden mutation, may be associated with adverse pregnancy outcome. The role of the prothrombin G20210A mutation remains to be elucidated.

Maternal plasma level of thrombomodulin is increased in mild preeclampsia

The purpose of this study was to determine if plasma thrombomodulin levels, a glycoprotein found on the surface of the endothelial cell, are elevated in pregnant women with mild preeclampsia and if these levels correlated with other features of disease severity. Parameters were compared in three groups of women: (I) 30 pregnant women with mild preeclampsia, (II) 30 normotensive pregnant women of similar lengths of gestation, and (III) 30 normotensive healthy young women. Thrombomodulin levels were significantly elevated in women with preeclampsia as compared with those of gestation-matched pregnant and non-pregnant controls. There was no correlation between plasma thrombomodulin levels and creatinine and uric acid blood levels. It is thus suggested that plasma thrombomodulin levels are elevated in preeclampsia, even in its mild stage, reflecting a vascular endothelial damage.

The effect of transdermal estradiol on the conjunctiva in postmenopausal women

OBJECTIVE To evaluate the effect of hormonal replacement therapy on the conjunctiva in postmenopausal women. STUDY DESIGN A prospective clinical study in the setting of a tertiary-care university hospital. Eleven postmenopausal women received hormonal replacement therapy (transdermal estradiol or transdermal estradiol plus medroxyprogesterone acetate) for 4 months. Serum estradiol levels as well as vaginal and conjunctival maturation value (a cytological parameter) were measured before and after the treatment. Data were analysed using the Wilcoxon matched pairs signed-Rank test. RESULTS A significant increase of serum estradiol levels (P < 0.01) and of vaginal maturation value (P < 0.01) were found. Cytological maturation changes in conjunctival epithelium were also observed. These changes, although mild, were statistically significant (P < 0.01). CONCLUSION These data support the view that the hormonal replacement therapy induces cytological maturation changes in conjunctival epithelium in postmenopausal women.

Laparoscopic management of unicornuate uterus with non-communicating rudimentary horn (three cases)

This article describes the laparoscopic management of unicornuate uterus with a non-communicating rudimentary horn in three women who presented with lower abdominal pain and dysmenorrhoea. The patients were managed with laparoscopic removal of the rudimentary horn along with the ipsilateral salpinx. No complications were noted intraoperatively and the patients remain asymptomatic.

Provocative tests of prolactin before, during and after long-term danazol treatment in patients with endometriosis

Ten patients suffering from endometriosis were treated with danazol at a dose of 200 mg three times daily for 6 months. To evaluate prolactin secretion, a thyrotropin releasing hormone (TRH) test and an insulin challenge test were carried out in the follicular phase before treatment, during the 6th month of treatment and after the reappearance of the second menses. The same tests were also performed, only once, in the follicular phase of ten normal women. The absence of a significant difference in basal prolactin levels as well as the response to the TRH and insulin challenge tests between controls and patients with endometriosis, before and after danazol treatment, support the view that hyperprolactinemia should not be considered as a cause of infertility in endometriotic women. Furthermore, the significant reduction of prolactin response to provocative tests during danazol treatment may be associated with the low estrogen levels caused by the medication. Finally, the inadequate prolactin response to insulin-induced hypoglycemia in patients with endometriosis and in normal women shows that this provocative test is not so effective for hypothalamic stimulation of prolactin.

Postparacentesis bilateral massive vulvar edema in a patient with severe ovarian hyperstimulation syndrome

OBJECTIVE To report a case of bilateral massive vulvar edema following lower abdominal paracentesis in a patient with ovarian hyperstimulation syndrome. DESIGN Case report. SETTING University teaching hospital. PATIENT(S) A 32-year-old woman with primary infertility. INTERVENTION(S) The patient underwent ovarian stimulation with leuprolide acetate, highly purified FSH, and hCG. Because of the development of severe ovarian hyperstimulation syndrome, bilateral paracentesis through the lower abdominal quadrants was performed. MAIN OUTCOME MEASURE(S) Treatment of ovarian hyperstimulation syndrome. RESULT(S) Development of bilateral massive vulvar edema 24 hours after lower abdominal paracentesis. CONCLUSION This case report suggests that lower abdominal paracentesis could be the cause of vulvar edema development in ovarian hyperstimulation syndrome, probably due to a fistulous tract created between the peritoneal cavity and the subcutaneous tissues.

Etiopathology of Endometriosis

Although endometriosis is one of the most frequent problems in gynecology, its pathogenesis remains controversial and poorly understood. Many theories relating to the etiopathology of this disorder have been proposed. The celomic metaplasia hypothesis states that peritoneal mesothelium undergoes metaplasia, forming typical endometrial-like glands and stroma. The transplantation theory suggests implantation and subsequent growth of retrogradely shed, viable endometrial cells. The induction theory states that unknown substances released from shed endometrium induce undifferentiated mesenchyma to form endometriotic tissue. Regardless of which theory is correct, additional factors may be responsible for the expression of the disease. The possibility that the development and progression of endometriosis is associated with abnormal immune function and an inadequate response of the peritoneal defense system is currently the most recent hypothesis for the etiopathology of this disease.

Danazol influences gonadotropin secretion acting at the hypothalamic level

OBJECTIVES: The purpose of the study was to determine the influence of danazol on gonadotropin secretion. METHODS: Ten endometriotic patients were treated with danazol for 6 months. To evaluate gonadotropin and estradiol secretion, a gonadotropin‐releasing hormone (GnRH) test and a clomiphene citrate (CC) challenge test were carried out in the follicular phase before treatment, during the sixth month of treatment and after the reappearance of the second menses. The same tests were also performed, only once, in the follicular phase of ten normal women. RESULTS: GnRH‐stimulated gonadotropin response during danazol treatment was significantly higher than that in the same group of women before and after danazol treatment, as well as in controls. Gonadotropin increase after clomiphene citrate administration during danazol treatment was not significant; moreover, LH response was significantly lower than that in the same group of patients before and after danazol treatment, as well as in controls. CONCLUSIONS: Our results suggest that danazol exerts a suppressive effect on gonadotropin secretion acting at the hypothalamic level.

Cyclosporine in the Management of Impetigo Herpetiformis: A Case Report and Review of the Literature

A 27-year-old female, gravida 1, para 0, in week 22 of pregnancy, presented with an eruption consisting of annular erythematosquamous plaques with an active polycyclic elevated border comprised of superficial micropustules. Clinical and histological features were typical of impetigo herpetiformis (IH). Systemic steroids resulted in an unstable condition, with no resolution of lesions. Resistance to the above therapeutic scheme served as a stimulus to discuss the use of cyclosporine as a therapeutic option in this condition. Reviewing the limited literature, cyclosporine seems to serve not as a monotherapy in the management of IH but as an additional medication, in order to achieve a stable course of the disease and avoid high doses of systemic steroids.

Visfatin serum levels are increased in women with preeclampsia: a case-control study.

Objective: Visfatin has been implicated in the pathogenesis of preeclampsia with limited and contradictory, however, results. The aim of this study was to investigate the potential association between visfatin serum concentration and preeclampsia. Methods: Visfatin was determined in the serum of 38 women with preeclampsia and 38 women with uncomplicated pregnancies, matched for age and gestational age. Results: Similar baseline characteristics were present between the two groups in terms of age, body mass index, parity and gravidity. Serum visfatin was significantly increased in the preeclamptic women (median = 10.3 ng/mL; interquartile range [IQR] = 20) as opposed to their matched controls (median = 2.6 ng/mL; IQR = 1.4) (p < 0.001). Univariate analysis revealed a strong linear correlation of visfatin levels with systolic (r = 0.505, p < 0.001), diastolic (r = 0.467, p < 0.001) and mean arterial blood pressure (r = 0.497, p < 0.001), as well as with uric acid concentrations in the serum (r = 0.463, p < 0.001). A receiver operating characteristics curve analysis illustrated that serum visfatin concentration is helpful in discriminating between preeclamptic or nonpreeclamptic women with an area under the curve of 0.887 (95% confidence interval [CI]: 0.794–0.948; p < 0.001). Conclusion: Visfatin serum concentration seems to be increased in preeclampsia as compared with uncomplicated pregnancy.