Guy Gutman

The Significance of Clinical Signs and Blood Indices for the Diagnosis of Appendicitis during Pregnancy

Objective: To evaluate the significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Sample: Of the 40,112 women delivering at our institution (January 1995 to June 2002), 38 women (0.094%) were operated due to the suspicion of appendicitis during pregnancy. Methods: Body temperature, clinical examination, white blood cell counts and lag time from arrival to operation were obtained for each patient. All women were operated with the clinical diagnosis of appendicitis, and their appendices were removed and examined by a pathologist. Results: Inflammatory appendix was discovered in 19 (0.047%) of the pregnancies with subsequent deliveries while a normal appendix was found in 19 of the 38 (50%) appendices removed. The group with normal appendix did not significantly differ from women with inflamed appendix with regard to gestational age at presentation, signs of peritoneal irritation, body temperature, leukocyte count, time elapsed between arrival and surgery, gestational age at delivery and birth weight. Conclusions: The accurate diagnosis of appendicitis during pregnancy is a difficult task requiring a very high level of suspicion and clinical skills and not merely relying upon laboratory and classic signs.

Recombinant luteinizing hormone induces increased production of ovarian follicular adiponectin in vivo: implications for enhanced insulin sensitivity

OBJECTIVE To determine in vivo whether LH supplementation during the late follicular phase induces increased production of ovarian follicle adiponectin in humans. DESIGN Randomized, double-blind, placebo-controlled study. SETTING Academic tertiary care medical center. PATIENT(S) Twenty infertile, healthy women (aged 18-39 years) undergoing IVF. INTERVENTION(S) Administration of recombinant FSH after down-regulation and equal randomization of subjects to receive recombinant LH 75 IU/day or placebo when two or more follicles reached a mean diameter of 14 mm. MAIN OUTCOME MEASURE(S) Follicular fluid (FF) adiponectin levels were measured. RESULT(S) Adiponectin FF levels were significantly higher in the recombinant LH group compared with the placebo group, and these differences were unaltered after correction to estrogen (E) levels and number of follicles in each cycle. CONCLUSION(S) This is the first demonstration of in vivo induction of adiponectin by gonadotropins in the human ovary. The addition of recombinant LH during the late follicular phase may enhance follicular insulin sensitivity, resulting in decreased androgen levels through a cascade mediated by increased production of adiponectin.

Regulation of vascular endothelial growth factor-A and its soluble receptor sFlt-1 by luteinizing hormone in vivo: implication for ovarian follicle angiogenesis

OBJECTIVE To determine in vivo whether LH supplementation during the late follicular phase induces ovarian follicle angiogenesis in humans, as reflected by vascular endothelial growth factor (VEGF)-A, its soluble receptor sFlt-1, and placental growth factor (PlGF) expression. DESIGN Randomized, double-blind, placebo-controlled study. SETTING Academic tertiary care medical center. PATIENT(S) Twenty infertile, healthy women (aged 18-39 years) undergoing IVF. INTERVENTION(S) Administration of recombinant FSH after down-regulation and equal randomization of subjects to receive recombinant LH 75 IU/day or placebo when two or more follicles reached a mean diameter of 14 mm. MAIN OUTCOME MEASURE(S) Serum and follicular fluid (FF) VEGF-A, sFlt-1, and PlGF protein levels were measured. RESULT(S) Recombinant LH increased both the FF VEGF-A/sFlt-1 ratio statistically significantly and PlGF/sFlt-1 insignificantly. Recombinant LH did not affect the serum VEGF/sFlt-1 ratio. Plasma levels of PlGF were undetectable. CONCLUSIONS This in vivo study demonstrates for the first time in humans that LH induces ovarian follicular angiogenesis via modulation of VEGF-A and its soluble receptor sFlt-1 expression. A constant VEGF-A/sFlt-serum ratio may prevent adverse effects of VEGF-A. Because angiogenesis is essential during the periovulatory period, recombinant LH supplementation during the late follicular phase may improve ovulation induction outcome.

CYP1A1 and CYP2D6 gene polymorphisms in Israeli Jewish women with cervical cancer.

Hypothesis: To assess the frequency distribution of the CYP1A1 and CYP2D6 gene polymorphisms in Israeli Jewish women with cervical cancer. Methods: Forty-three Israeli Jewish women with cervical cancer and 123 healthy Israeli Jewish women were assessed. CYP1A1 (2 alleles) and CYP2D6 polymorphism was analyzed using an allele-specific, polymerase chain reaction-based method. Results: The allele frequency and genotype distribution for the CYP1A1 (2 alleles) and CYP2D6 polymorphism did not reach a level of significance. Smoking was the only independent risk factor for cervical cancer (P = 0.0003). Conclusion: CYP1A1 and CYP2D6 mutations are not related to an increased risk for cervical cancer in the Jewish Israeli population.

Prediction of cervical involvement in endometrial cancer by hysteroscopy

AbstractObjectiveThis study evaluated the ability of hysteroscopy to preoperatively predict cervical involvement in endometrial cancer.MethodsThe records of 110 surgically staged consecutive endometrial cancer patients treated at our institution from 1997 to 2003 were retrospectively analyzed. Data on demographics, preoperative staging procedures, surgical pathology reports, and adjuvant treatments were retrieved.ResultsFourteen (12.7%) patients had cervical involvement (stage II) according to the surgical pathology report, of whom nine (8.1%) had stage IIA and five (4.6%) had stage IIB. Clinical evaluation by speculoscopy and palpation had failed to reveal any indication of cervical involvement. Preoperative diagnostic hysteroscopy procedures were included. None of the hysteroscopy procedures revealed any suspicious lesion in the cervical canal. ConclusionHysteroscopy and clinical examination fail to adequately predict cervical involvement in endometrial carcinoma. Fractional D&C appears to be the best method until a more effective alternative becomes available.