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Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertility

OBJECTIVE To assess the safety and efficacy of hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. DESIGN Retrospective case report series. SETTING The obstetrics and gynecology clinic of a medical school. PATIENT(S) Forty women with recurrent pregnancy loss or infertility resulting from intrauterine adhesions. INTERVENTION(S) Hysteroscopic adhesiolysis in patients with recurrent pregnancy loss and infertility. MAIN OUTCOME MEASURE(S) Postoperative adhesion formation, intraoperative complication, conceivement after surgery, pregnancy rate, and pregnancies resulted in term or viable preterm infants. RESULT(S) Most patients with minimal or moderate adhesions were free of adhesions when compared with postoperative control subjects. However, adhesion re-formation was noted in 60% of the patients who initially had severe adhesions. Normal menstrual flow was restored in 81% of the patients. All the patients who had recurrent pregnancy loss conceived after treatment, and 71% of the pregnancies resulted in a term or viable preterm infant. Of the 16 infertile patients treated, 10 (63%) conceived and 6 (37%) were delivered of viable infants. CONCLUSION(S) Hysteroscopic adhesiolysis is a safe and effective procedure for restoring the normal menstrual pattern and fertility. The initial severity of the adhesions appears to correlate best with the reproductive outcome.

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance

The aim of this study was to evaluate ischemia-modified albumin levels (IMA) in polycystic ovary syndrome (PCOS) cases with and without insulin resistance and the correlation of IMA with carotid intima media thickness, homocysteine, and high-sensitivity C-reactive protein levels. Significantly higher levels of IMA in young lean PCOS cases, more relevant in insulin resistant cases, indicates chronic hypoxia and oxidative stress which might play a role in the metabolic consequences in PCOS.

C-reactive protein and homocysteine levels are associated with abnormal heart rate recovery in women with polycystic ovary syndrome

OBJECTIVE To determine heart rate recovery (HRR) in patients with polycystic ovary syndrome (PCOS) and its relation to C-reactive protein (CRP) and homocysteine (Hcy) levels. DESIGN Prospective clinical study. SETTING University hospital. PATIENT(S) Sixty-eight women with PCOS and 68 healthy women were included this study. INTERVENTION(S) Heart rate recovery was evaluated. We measured serum levels of CRP and Hcy. The presence of insulin resistance was investigated using homeostasis model assesment (HOMA-IR). MAIN OUTCOME MEASURE(S) Heart rate recovery, CRP, Hcy. RESULT(S) Heart rate recovery was significantly decreased in women with PCOS compared with control group women. Subjects with abnormal HRR had significantly greater levels of CRP and Hcy. The PCOS patients with HRR in the top tertile compared with the bottom quartile tended to have lower mean CRP and Hcy levels. The HRR was significantly and negatively correlated with age, CRP, Hcy, HOMA-IR, and body mass index. C-reactive protein and Hcy are independent determinants of HRR. CONCLUSION(S) The CRP and Hcy levels may affect the development and progression of abnormal HRR in PCOS.

Unexpected Nature of a Pelvic Mass in Pregnancy: Castleman's Disease

The obstetrician is rarely confronted with a pregnant patient who presents with a large suspicious pelvic mass. Diagnostic tools are not always of value and laparotomy may be performed for obstetric and histopathologic reasons. In this article we present an interesting case of an unusual pelvic mass in pregnancy secondary to benign lymphoepithelial disease (Castlemans disease). We could not find a case similar to the one reported in the medical literature.

The association of urinary albumin excretion and metabolic complications in polycystic ovary syndrome

OBJECTIVE This study was planned to screen polycystic ovary syndrome (PCOS) women for albuminuria and to evaluate the association between urinary albumin excretion (UAE) and metabolic disturbances of PCOS. In addition, this is the first study in the literature evaluating the association between UAE and carotid intima-media thickness (CIMT) in PCOS cases. STUDY DESIGN The study population consisted of 65 PCOS women. The study was prospectively designed and performed in a university hospital. The diagnosis of PCOS was made according to the Rotterdam criteria: exclusion criteria were hyperprolactinemia, thyroid dysfunction, adrenal dysfunction, diabetes mellitus, hypertension, and pregnancy. Blood samples were collected in the follicular phase of a menstrual cycle and serum samples were analyzed for fasting glucose, insulin, and hormone and lipid profiles. Twenty-four hour urine specimens were collected for the detection of UAE. CIMT was estimated by visual assessment of the distance between the lumen-intima and intima-adventitia interfaces. RESULTS The mean age and BMI were 23 years and 23 kg/m(2), respectively. The median UAE was 7 mg/day (range: 0.3-154 mg/day). The median UAE as micrograms of albumin per milligram of creatinine (uACR) was 5.6 (0.28-159). Regarding the uACR cutoff value (>6.93 μg/mg), significantly higher levels of triglycerides, 17 OH-progesterone, insulin resistance (HOMA index > 2.1) and increased CIMT were present in these cases. Microalbuminuria (uACR > 25 μg/mg) was present in 6.2%. In the regression analyses serum HDL-C levels were found to be independent predictor for uACR > 2 μg/mg (OR: 0.85) and estradiol levels were the independent predicting factor for uACR > 6.93 μg/mg even after adjustments for age and BMI were performed (OR:1.02). CONCLUSIONS UAE, expressed as uACR > 6.93 μg/mg, seems to be an associated sign of metabolic problems which might help in discriminating PCOS at risk of future CVD. Further studies are needed before routine use of albuminuria in PCOS cases for the detection of CVD risk.

Spironolactone in the treatment of hirsutism.

SummarySpironolactone was used in 90 hirsute women because of its antiandrogenic effect. The drug was administered twice daily from the 4th to the 22nd day of six cycles (total dosage was 200 mg per day). The results suggest that spironolactone is suitable for the treatment of hirsutism.

Predictive value of amniotic fluid volume measurements on perinatal outcome

Amniotic fluid volumes were measured in 1,659 pregnant women to determine the predictive value of these measurements on perinatal outcome. All cases were evaluated by other tests of fetal well-being. 128 cases were oligohydramniotic, and 1,531 cases were normal. In all cases, several parameters were assayed, e.g. fetal distress, way of delivery, meconium in amniotic fluid, Apgar score, transfer to pediatric clinics and early-late neonatal complications. The results of the perinatal evaluation of oligohydramnios were as follows: assessing fetal distress: specificity 94.2%, sensitivity 18.4%, positive predictive value 35.9%, negative predictive value 86.7% and accuracy 82.8%, and assessing low Apgar score the values were 93.0, 21.3, 95.9 and 89.5%, respectively. As a result, measurement of the amniotic fluid volume is an important parameter predicting perinatal outcome, and its predictive value increases if it is combined with other fetal well-being tests with different end points.

Malignant melanoma arising in an in vitro fertilisation pregnancy: A case report

Malignant melanoma diagnosed during pregnancy results in confusion about staging and management. In this case report, a 39-year-old pregnant woman, who had undergone conception via in vitro fertilisation, was diagnosed with malignant melanoma of a growing lesion on her back in the 20th week of gestation. She delivered her baby by caesarean section in the 38th week. Metastasis was not found by chest X-ray, ultrasonography and positron emission tomography after delivery. She has been disease free for 6 months postpartum. Surgical resection of malignant melanoma and postponing of the sentinel lymph node biopsy has been proposed. Risk of adverse perinatal outcomes has not been increased; but the prognosis of malignant melanoma is known to be poorer when diagnosed during pregnancy. As a conclusion, any pigmentary change in the nevi should be assessed carefully during pregnancy.

Primary squamous cell carcinoma of the endometrium

15@300 mg pamidronate daily tolerated treatment reasonably well but those receiving 450-600 mg daily had an unacceptable incidence of adverse events. The toxicities in patients receiving the effervescent tablet, at all dose levels, tended to be worse and in view of its inconvenient mode of administration, this formulation will not be studied further. 5 patients taking the effervescent formulation and 2 receiving the enteric-coated capsule stopped treatment because of poor tolerability. Studies of oral pamidronate as an adjunct to systemic therapy are now indicated. Toxicity was infrequent with the entericcoated capsule at a dose of 150-300 mg daily and is therefore suitable for further study. However, the search continues for an even better tolerated formulation.

The Impact of Body Mass Index on ART Outcomes of High-Responders: Prospective Cohort Study

Objective: Is to evaluate the impact of body mass index (BMI) levels on pregnancy outcomes in high-responders undergoing assisted reproductive technology (ART). Material and Methods: Total of 120 high responders was allocated to the study. High response was defined as having high serum AMH levels (>4 ng/ml). Subjects were divided into three groups according to their BMI values; normal weight 57 (BMI 18.5–24.9 kg/m2), overweight 42 (25-29.9 kg/m2) and obese 21 subjects (BMI ≥30 kg/m2) were compared for pregnancy outcomes and Ovarian Hyperstimulation Syndrome (OHSS) rates. Gonadotropin starting dose was fixed to 150 IU/day in antagonist co-treated cycles for all subjects. Results: A total of 120 cycles were evaluated. In patients with BMI ≥30 kg/m2, the total gonadotropin use was significantly higher (p<0.001) and number of retrieved oocytes was significantly lower (p=0.001) when compared to other groups. In normal weight patients, significantly higher numbers of mature oocytes and 2PN embryos were obtained when compared with other groups (p<0.001). Other parameters including number of good quality embryos available for transfer, implantation, biochemical, clinical pregnancy and OHSS rates were similar between all groups. Conclusion: Our results did not reveal a significant effect of BMI on the ART outcomes of high responder infertile women. Although higher BMI was correlated with less number of retrieved oocytes, it did not resulted with a negative impact on pregnancy outcomes. Another interesting finding was the trend to a less OHSS incidence with the increase in BMI of high responder patients.