So Jung Liang

Inappropriate gonadotropin secretion in polycystic ovary syndrome.

OBJECTIVE To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). DESIGN Retrospective study. SETTING Academic tertiary center. PATIENT(S) A total of 373 women were classified into three groups: [1] healthy control women (n = 48); [2] women who were positive for PCOS risk factor; and [3] women with PCOS (n = 251). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. RESULT(S) The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. CONCLUSION(S) The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS.

Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40

BACKGROUND The clinical features and metabolic complications of polycystic ovary syndrome (PCOS) may change with age. This study was designed to investigate the clinical and biochemical characteristics of PCOS patients between the ages of 20 and 40. METHODS The study included 781 Taiwanese women, of whom 453 were diagnosed with PCOS and 328 were non-PCOS controls. Anthropometric components, androgens, endocrine, insulin resistance, and metabolic components were measured and correlated with age. Above parameters were compared between younger and elder women with PCOS. RESULTS Age had significant negative correlations with androgens (total testosterone and dehydroepiandrosterone sulfate), the modified Ferriman-Gallwey score and the prevalence of acne and hirsutism. Age had significant positive correlations with fasting glucose, cholesterol, triglycerides and low-density lipoprotein. The 453 women who fulfilled diagnostic criteria for PCOS were classified by age into two groups: Group A (20-29 years old, n= 294) and Group B (30-40 years old, n= 159). Group A had significantly higher total testosterone levels than Group B. Group B had higher fasting insulin and glucose levels, triglycerides, body mass index and waist measurements and a higher incidence of obesity than Group A. The average ovarian volume was not significantly different among the two groups. CONCLUSIONS Increased age is accompanied by a decrease in the prevalence of both clinical and biochemical hyperandrogenism in women. Hyperandrogenism is the important factor for young women with PCOS; however, abdominal obesity and certain metabolic disturbances became major concerns for older women with PCOS.

ISOLATED TORSION OF THE FALLOPIAN TUBE: A RARE DIAGNOSIS IN AN ADOLESCENT WITHOUT SEXUAL EXPERIENCE

is usually established after surgical intervention. A 19-year-old adolescent, who denied any sexual experience, was twice presented with sudden onset of lower abdominal pain, predominantly in the left lower quadrant, in the last year. The first episode occurred 1 year previously and the patient was brought to our emergency room. The abdominal pain was sharp, persistent, non-radiating and mainly in the left lower quadrant of abdomen, but with no obvious peritoneal signs. Plain abdominal film showed much fecal material retained in the large bowel. Enema and nonsteroidal antiinflammatory drug were prescribed. The tenderness was relieved. She was discharged with the presumptive diagnosis of stool impaction. Unfortunately, she experienced a second episode of

Obesity is the predominant predictor of impaired glucose tolerance and metabolic disturbance in polycystic ovary syndrome

Objective. To evaluate the contribution to glucose intolerance and metabolic syndrome of obesity combined with the diagnostic criteria of polycystic ovary syndrome (PCOS). Design. Prospective study. Setting. University teaching hospital from 31 August 2010 to 31 August 2011. Population. Two hundred and twenty women with PCOS and seventy normal control women. Methods. The clinical and biochemical characteristics of women with PCOS and control women were evaluated. Main outcome measures. The impact of obesity, hyperandrogenism, oligo‐anovulation and polycystic ovary morphology on impaired glucose tolerance and metabolic disturbances. Results. Obese women with PCOS had significantly higher insulin resistance than obese normal control women. Logistic regression analysis showed that obesity was the only factor that predicted impaired glucose tolerance and metabolic syndrome. Use of the area under the receiver operating characteristic curve (AUROC) for the body mass index to predict impaired glucose tolerance and metabolic syndrome was more accurate than AUROCs for serum total testosterone level and the average menstrual interval. Conclusions. Body weight status was the major factor determining the risk of impaired glucose tolerance and metabolic syndrome in women with PCOS. Obesity should be treated as the major factor determining long‐term health consequences associated with PCOS.

VERY EARLY STAGE ADENOCARCINOMA ARISING FROM ADENOMYOSIS IN THE UTERUS

OBJECTIVE Malignant transformations of adenomyosis in premenopausal women with normal endometrium are extremely rare. We report a case of adenocarcinoma arising from an adenomyotic focus in the uterus, which was found unexpectedly in a woman undergoing myomectomy for adenomyosis. CASE REPORT A 47-year-old premenopausal woman presented with massive vaginal bleeding and anemia. She was admitted and underwent myomectomy under the initial diagnosis of uterine leiomyoma. Microscopic studies revealed endometrioid adenocarcinoma, which was a malignant transformation of a focus of adenomyosis in the surgical specimen. A total hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymphadenectomy was then performed. Pathologic studies showed no residual tumors in the entire resected specimen except for the previous lesion. The endometrium had normal thickness with mild proliferative activity throughout the cavity. There was no atrophic or hyperplastic change in the whole endometrium. The adenocarcinoma was present exclusively in the myometrium, and a transition between the carcinoma and the adenomyotic glands was observed. CONCLUSION This case report presents evidence that adenocarcinoma may a rise de novo from an adenomyotic lesion in the uterus.

Polycystic ovary syndrome or hyperprolactinaemia: a study of mild hyperprolactinaemia

Polycystic ovary syndrome (PCOS) and hyperprolactinaemia are both common causes of secondary amenorrhoea in reproductive women. The relationship between PCOS and hyperprolactinaemia has been reported with controversial results. To evaluate the clinical and laboratory features of women with mild hyperprolactinaemia and PCOS, we studied 474 Taiwan Chinese women: 101 had mild hyperprolactinaemia, 266 had PCOS and 107 were the control group. In this study, we found that 64% of the women with mild hyperprolactinaemia fulfilled the PCOS diagnostic criteria, regardless of their prolactin levels. Obese women with PCOS had significantly lower luteinising hormone (LH) and LH-to-FSH ratios than non-obese women with PCOS. Obese hyperprolactinaemic women had significantly lower follicle-stimulating hormone (FSH), but higher LH-to-FSH ratios than the non-obese hyperprolactinaemic women. For women with PCOS, the BMIs were significantly negative with LH (γ = −0.253, p < 0.001), but not with FSH (γ = −0.061, p = 0.319). For the hyperprolactinaemic women, the BMIs were significantly negative with FSH (γ = −0.353, p < 0.001), but not with LH (γ = −0.021, p = 0.837). Although PCOS-related syndrome was very prevalent in women with hyperprolactinaemia, the patterns of disturbance in gonadotropin secretion were different between the PCOS and the hyperprolactinaemia patients.

Effects of different arginine concentrations on angiogenic protein production induced by HeLa cells

OBJECTIVES This in vitro study investigated the effects of different arginine (Arg) concentrations on angiogenic protein expressions of HeLa cells and endothelial cells (ECs) after stimulation. In addition, an inducible nitric oxide (iNO) synthase inhibitor (1400W) was used to investigate the possible role of iNO in angiogenesis. METHODS Endothelial cells and HeLa cells were treated with different concentrations of Arg and 1400W: Arg 0, 50, 100, and 1000 micromol/L; Arg 100 micromol/L+1400W 10 micromol/L; and Arg 1000 micromol/L+1400W 10 micromol/L for 24 h. Then, ECs and HeLa cells were cocultured for 2 h, and the supernatant in the transwell was collected for analysis of angiogenic protein secreted. The expression of CD51/CD61 by ECs was also analyzed. RESULTS The productions of vascular endothelial growth factor, basic fibroblast growth factor, prostaglandin E(2), and matrix metalloproteinase-2 were higher with Arg 100 and 1000 micromol/L than with Arg 0 and 50 micromol/L Arg, and this was consistent with the expression of CD51/CD61 by ECs. Inhibition of iNO production resulted in lower angiogenic protein expressions comparable with groups with low Arg administration. CONCLUSION The findings of this study suggest that Arg administration at levels similar to or higher than physiologic concentrations enhance the production of angiogenic protein and iNO may partly play a role in promoting angiogenesis in the presence of HeLa cells.

Polycystic Ovarian Syndrome in Taiwanese Women

Polycystic ovary syndrome (PCOS) is an extremely common disorder in women of reproductive age. Diagnosis of PCOS is principally based on clinical and physical findings. Diagnostic criteria and PCOS definitions used by clinicians and researchers are almost as heterogeneous as the syndrome. Of those diagnosed with PCOS using the 2003 Rotterdam criteria, 61% fulfilled the 1990 National Institutes of Health criteria for unexplained hyperandrogenic chronic anovulation. Patient populations with the new phenotypes have less severe ovulatory dysfunction and less androgen excess than patients diagnosed using the 1990 National Institutes of Health criteria. These findings might be common across all female populations with PCOS, in Asian or Western countries. Data for clinical hyperandrogenism indicates that the prevalence of hirsutism in Taiwanese PCOS women is lower than that for Caucasian/Western women. The extent of metabolic abnormalities in women with PCOS may vary with phenotype, age and ethnicity. Obesity represents a major risk factor for metabolic syndrome and insulin resistance. Approximately 40–50% of all women with PCOS are overweight or obese. Obese subjects with PCOS have a higher risk of developing oligomenorrhea, amenorrhea and biochemical hyperandrogenemia than non-obese women with PCOS. Moreover, obese women with PCOS have significantly more severe insulin resistance, lower serum luteinizing hormone levels, and lower luteinizing hormone to follicle-stimulating hormone ratios than those of non-obese women with PCOS. PCOS women in Taiwan have a higher luteinizing hormone to follicle-stimulating hormone ratio and lower insulin resistance than those in PCOS women in Western countries. However, the average body mass index is significantly lower in Taiwanese PCOS women than in Western women, which might partially explain the difference between these two populations in terms of clinical and biochemical presentations. To further document the ethnic variation between women with PCOS in Taiwan and Western countries, future studies should pay attention to the effect of obesity on the diagnosis and clinical presentations of PCOS-related syndromes.

Efficacy of Mifepristone/Misoprostol Combination for Medical Abortion Determined by Detection of Retained Products in a Community Hospital in Taipei, Taiwan

Summary Objective The oral mifepristone/misoprostol combination (MMC) is safe for medical abortion in early pregnancy. The rate of complete abortion in MMC-treated pregnancies at a community hospital in Taipei, Taiwan, was determined by ultrasonography and histopathology. Materials and Methods A total of 149 women who asked for legal termination of pregnancy before 49 days since the last menstruation were given 600 mg of oral mifepristone followed by 600 μg misoprostol 48 hours later. After 14 days, all women who had vaginal spotting or bleeding and in whom transvaginal ultrasonography demonstrated an endometrial thickness of more than 10 mm underwent vacuum aspiration or therapeutic dilatation and curettage (D&C). Specimens were identified by histopathology. Results A total of 108 women had complete abortions without the need for surgical intervention. Of 41 women who underwent vacuum aspiration or therapeutic D&C, histopathology showed that nine had decidual tissue, 29 had gestational tissue, and three had ongoing pregnancies. Conclusion In this study, the complete abortion rate was 78.5% after oral MMC.

Partial Hydatidiform Mole in a Medical Abortion with the Mifepristone/Misoprostol Combination

Summary Objective Gestational trophoblastic disease after an early elective medical abortion with the mifepristone/ misoprostol combination (MMC) is rare. Case Report We report a case of a young woman who was at 6–7 weeks of gestation who requested a medical abortion. The pretreatment ultrasonogram indicated a normal pregnancy. Passage of tissue ensued after the MMC, with good recovery. Postabortal ultrasonogram on day 14 showed the presence of intracavitary content. The patient declined our suggestion of serial ultrasonographic surveillance, and she was later lost to follow- up. Fifty days after the initial treatment, she again presented to our hospital with intermittent bleeding and an increase in the blood flow signal with a low resistance index in the uterus on color Doppler ultrasonography. After curettage, she was diagnosed as having a partial hydatidiform mole; she had complete regression of beta- human chorionic gonadotropin, monitored for 1 week after the evacuation. Conclusion Obstetricians should be aware of the possibility of a partial hydatidiform mole after a medical abortion.