European Journal of Obstetrics & Gynecology and Reproductive Biology - Articles in Press

Quality of life scores improve in women undergoing colpocleisis: a pilot study - Corrected Proof

A. Özgür Yeniel, A. Mete Ergenoglu, Niyazi Askar, İsmail Mete Itil, Reci Meseri — 2012-05-07

Abstract: Objective: To evaluate the quality of life and surgical outcomes in women who had undergone colpocleisis.Study design: This was a prospective small cohort study conducted between August 2010 and September 2011. Twelve women with pelvic organ prolapse were offered obliterative vaginal surgery and were informed about the surgical procedure. Ten women accepted this operation and were included in the study. Before and after colpocleisis, cases were evaluated by urogynecological examination, and quality of life was assessed by the Turkish language validated prolapse quality of life questionnaire (P-QOL), in which a low total score indicates a good quality of life.Results: The mean age was 74.9±4.5 (range 68–85). The general score of the P-QOL was reduced during the follow-up period, reflecting a significant effect on quality of life and clinical improvement in women with the colpocleisis operation. There was no morbidity due to colpocleisis or recurrent pelvic organ prolapse in follow-up period.Conclusion: In our small cohort including elderly women, colpocleisis provided high levels of surgical outcomes as well as a significant improvement in quality of life without significant morbidity.

Perinatal risk-indicators for long-term respiratory morbidity among preterm or very low birth weight neonates - Corrected Proof

2012-05-03

Abstract: Objectives: To develop prediction models for long-term respiratory morbidity. To explore if respiratory distress syndrome (RDS) is a risk-indicator for long-term respiratory morbidity and to identify other perinatal risk-indicators for long-term respiratory morbidity.Study design: In the Dutch POPS cohort 1338 live born infants delivered in The Netherlands in 1983, either before 32 completed weeks gestation and/or with a birth weight below 1500g, were followed prospectively. We used multivariable logistic regression analyses to construct three prediction models for respiratory morbidity at 2, 5 and 19 years of age.Results: At 2 years of age, maternal smoking (adjusted OR 1.5, 95% CI 1.0–2.4), prolonged rupture of membranes (adjusted OR 2.3, 95% CI 1.3–4.1), pre-eclampsia (adjusted OR 1.9, 95% CI 1.1–4.1), male gender (adjusted OR 1.5, 95% CI 1.1–2.0) and BPD (adjusted OR 1.9, 95% CI 1.1–3.2) were significantly associated with respiratory morbidity. Prolonged rupture of membranes (adjusted OR 3.7, 95% CI 1.6–8.5), family history of asthma (adjusted OR 5.9, 95% CI 2.7–13.0) and BPD (adjusted OR 1.8, 95% CI 1.1–3.0) were significantly associated with respiratory morbidity at 5 years of age. At 19 years of age only higher social class was associated with decreased respiratory morbidity (adjusted OR 0.64, 95% CI 0.41–0.99). The areas under the curves (AUC) were 0.65, 0.71 and 0.61 respectively. The prediction models for respiratory morbidity at 2 and 5 years of age showed a good calibration, while the calibration plot for respiratory morbidity at 19 year was less optimal.Conclusions: RDS is not a risk-indicator for long-term respiratory morbidity at 2, 5 and 19 years in this cohort (OR 1.2, 95% 0.88–1.7; 1.3, 95% 0.88–2.0; OR 0.91, 95% 0.56–1.5 respectively). Future obstetric studies interested in the effect of a specific perinatal intervention on long-term respiratory morbidity, should consider taking bronchopulmonary dysplasia (BPD) as primary outcome instead of RDS.

Stress urinary incontinence following vaginal trauma involves remodeling of urethral connective tissue in female mice - Corrected Proof

Huey-Yi Chen, Yu-Ning Lin, Yung-Hsiang Chen, Wen-Chi Chen — 2012-05-01

Abstract: Objective: The molecular mechanisms underlying stress urinary incontinence (SUI) are not clear. This study was conducted to evaluate molecular alterations in the urethras of mice with experimentally induced SUI.Study design: Eighteen virgin female mice were equally distributed into three groups as follows: two groups undergoing vaginal distension (VD) for 1h with 3mm and 8mm dilators each, and a non-instrumented control group. Changes in leak point pressure (LPP), morphology, lysyl oxidase (LOX) expression and the metabolism of urethral connective tissue were assessed.Results: The LPP was significantly decreased in the 3mm and 8mm VD groups compared with that in the control group. Collagen and elastin expression in the urethra was significantly decreased in the 8mm VD group compared with that in the control group, while LOX expression was significantly enhanced.Conclusions: SUI following vaginal trauma involves over-expression of LOX and decreased synthesis of extracellular matrix components or increased proteolysis in the urethra.

Normal serum anti-Müllerian hormone levels in the general female population and the relationship with reproductive history - Corrected Proof

2012-05-01

Abstract: Objective: Anti-Müllerian hormone (AMH) has been evaluated by several groups as a potential novel clinical marker of ovarian reserve. Considering the wide use of AMH measurement in daily clinical practice and the large number of conditions in which it may be used, it is essential to establish reference values in the healthy female population. In this study we aim to calculate the age-by-age normal values of circulating AMH. In addition, we report on AMH levels in women according to BMI, smoking status and reproductive history.Study design: The study was performed at the Institute of Obstetrics and Gynecology, University of Modena, between January 2008 and December 2010. A total of 416 healthy women (aged 18–51) were recruited and serum AMH levels were measured for all of them. The centiles of AMH distribution were estimated with the CG-LMS method. The relationship between AMH levels and the womens’ characteristics such as BMI, smoking status and reproductive history was analysed by using the uni- and multi-variable regression analysis and the Chi-square test.Results: Serum AMH concentrations show a progressive decline with female ageing. Age-related nomograms for the 5th, 25th, 50th, 75th, and 95th percentiles of AMH were produced. Mean AMH concentrations were not modified by smoking habit and BMI and were independent of parity of the women.Conclusion: In the present study, we established age-specific reference values for circulating AMH levels in the eumenorrheic female population. AMH measurement produces new information on ovarian pathophysiology and ovarian reserve and the establishment of reference values for AMH is the first step for a correct interpretation of the assay.

Sibutramine administration decreases serum anti-Müllerian hormone (AMH) levels in women with polycystic ovary syndrome - Corrected Proof

2012-05-01

Abstract: Objective: To investigate the effect of diet, physical exercise and sibutramine administration on serum anti-Müllerian hormone (AMH) levels, hormonal and metabolic parameters in overweight and obese patients with polycystic ovary syndrome (PCOS).Study design: Prospective clinical study, in an outpatient clinic setting, of 76 overweight and obese women with PCOS. All patients were placed on a hypocaloric diet, physical exercise plus sibutramine (10mg per day) for the first month and then on either a hypocaloric diet, physical exercise plus sibutramine (10mg per day) or a hypocaloric diet and physical exercise for the subsequent 6 months. Serum AMH levels, body composition, hormonal and metabolic features and insulin sensitivity indices were evaluated at baseline and at 4 and 7 months of treatment.Results: Body weight reduction was greater in the sibutramine group. Moreover, serum FSH and testosterone levels decreased, and SHBG, free androgen index and all indices of insulin resistance significantly improved at 4 and 7 months. Serum AMH levels decreased only in PCOS women who received sibutramine, at both 4 and 7 months of treatment.Conclusion: A hypocaloric diet and a diet plus sibutramine both resulted in significant weight loss in overweight and obese women with PCOS. Patients who received sibutramine showed greater weight loss and improvement in hyperandrogenemia and insulin sensitivity after 7 months of treatment. Serum AMH levels significantly decreased at both 4 and 7 months of treatment only in PCOS women who received sibutramine, indicating a possible direct, gonadotropin independent effect of sibutramine on the ovarian production of AMH.

Pelvic actinomycosis with secondary liver abscess, an unusual presentation - Uncorrected Proof

2012-04-30

A previously healthy 38-year-old woman presented to the gynaecology out-patient clinic with a three-week history of intermittent fever and a tender mass in her lower abdomen. The patient denied weight loss or anorexia. Her last menstrual period had been three weeks prior to presentation and she reported regular menstrual periods. She had had an intrauterine contraceptive device (IUCD) in situ for four years. She denied any history of previous pelvic infection, inter-menstrual or post-coital bleeding. Her cervical smears had always been negative, her last smear having been performed three years previously. She denied any urinary symptoms.

Diagnosing genitourinary tuberculosis by exclusion - Corrected Proof

Martina Šunj, Tomislav Čanić, Marijan Tandara, Ivan Palada — 2012-04-30

We wish to present a case of genitourinary tuberculosis in a 27-year-old woman who emigrated 14 years ago from Bosnia and Herzegovina to Croatia. Ten days before attending the Emergency Room, she began experiencing periodic abdominal pains and subfebrile temperatures. She had no significant past medical history or family history. On presentation she complained of strong pelvic pain that began 4h earlier, and a temperature of 39°C that started a day before. She also complained of headache and fatigue. After our initial examination laboratory tests showed: erythrocyte sedimentation rate (ESR) 60mm/h, white blood cell count (WBC) 8×109/L, red blood cell count (RBC) 4.03×1012/L, hemoglobin (HB) 98g/L, hematocrit (HCT) of 0.29L/L, platelet count (PLT) 539×109/L and C-reactive protein (CRP) 118mg/L. Transvaginal ultrasonography showed masses of up to 8cm size with mixed echo patterns in the area of the ovarian fossa. Suspecting tubo-ovarian abscesses we treated her with intravenous antibiotics for ten days (ceftriaxone, metronidazole, and gentamicin).

Prevalence and risk factors of bacterial vaginosis during the first trimester of pregnancy in a large French population-based study - Corrected Proof

2012-04-26

Abstract: Objectives: Bacterial vaginosis is a risk factor for preterm delivery. Its prevalence and risk factors in Europe are not well known. Our objective was to assess both in early pregnancy.Study design: As part of the PREMEVA randomized controlled trial, this population-based study included 14,193 women screened before 14 weeks’ gestation for bacterial vaginosis in the 160 laboratories of the Nord-Pas-de-Calais region in France. Bacterial vaginosis was defined by a Nugent score≥7. Data were collected about maternal tobacco use, age, education, and history of preterm birth. We estimated the prevalence of bacterial vaginosis and used a multilevel logistic regression model to identify significant risk factors for it.Results: Among the 14,193 women assessed before 14 weeks’ gestation, the prevalence of bacterial vaginosis was 7.1% (95% CI: 6.6–7.5%). In the multivariate analysis, smoking during pregnancy tobacco (adjusted OR: 1.38; 95% CI: 1.19–1.60), maternal age 18–19 years (adjusted OR: 1.40; 95% CI: 1.01–1.93), and educational level (completed only primary school: adjusted OR: 1.77; 95% CI: 1.35–2.31; completed only secondary school: adjusted OR: 1.27; 95% CI: 1.10–1.48) were independent risk factors for bacterial vaginosis. History of preterm delivery was not an independent risk factor of bacterial vaginosis: adjusted OR: 1.15; 95% CI: 0.90–1.47.Conclusion: In a large sample of women in their first trimester of pregnancy in France, the prevalence of bacterial vaginosis was lower than rates reported in other countries, but risk factors were similar: young age, low level of education, and tobacco use during pregnancy. These results should be considered in future strategies to reduce preterm delivery.

Anti-Helicobacter pylori antibodies and polycystic ovary syndrome - Corrected Proof

Irfan Yavaşoglu, Mert Küçük — 2012-04-25

We were interested in the article published in your journal entitled “Anti-Helicobacter pylori antibodies in cervical mucus: a new cause of infertility” written by Ambrosini et al. . Here, we would like to emphasize some important points concerning the article.

Successful pregnancy outcome following triple organ transplantation (small intestine, liver and pancreas) - Corrected Proof

R. Srivastava, S. Clarke, G.L. Gupte, J.L. Cartmill — 2012-04-25

Improved health status and restoration of fertility following organ transplantation offer female recipients a better prospect of conceiving and bearing children. Although the number of reported pregnancies in transplant recipients has been increasing, figures have shown that there is a higher risk of adverse pregnancy and neonatal outcomes . Data obtained from the National Transplantation Pregnancy Registry (NTPR) have shown a 71–76% success rate of pregnancies in female kidney recipients and 50–86% for the other organs combined .

The painful black umbilicus - Corrected Proof

Neeta Singh, Praveen Kumar, Ranjoy Ghosh, Sunesh Kumar — 2012-04-25

We want to report an interesting case of a 38-year-old woman, para 2 live 2, who presented to the outpatient clinic with a complaint of a painful black umbilicus for eighteen months. There was no history of any surgery on the abdomen. Her menstrual cycles were regular with average flow and mild dysmenorrhea only. Her last childbirth was nine months back. She had taken anti-tubercular treatment for tuberculosis of the intestine in 2008 for nine months. There was no other significant past medical/surgical or family history. On abdominal examination there was a dark brownish nodule replacing whole of the umbilicus. It was fixed to the underlying skin and was minimally tender. Speculum and vaginal examinations revealed a healthy looking cervix and vagina and a multiparous-size mobile uterus. Fine needle aspiration cytology (FNAC) from the nodule suggested endometriosis. The patient underwent excision of the endometriotic nodule with umbilical reconstruction under general anesthesia, and was discharged the same evening. Histopathology confirmed umbilical endometriosis. Pre-operative and post-operative pictures and the specimen are shown in . The patient is symptom-free at one year follow-up.

Functional outcomes for surgical revision of synthetic slings performed for voiding dysfunction: a retrospective study - Corrected Proof

Gerard Agnew, Peter L. Dwyer, Anna Rosamilia, Geoffrey Edwards, Joseph K. Lee — 2012-04-23

Abstract: Objective: To determine the functional outcomes after synthetic sling revision surgery performed for voiding dysfunction.Study design: A retrospective review of 63 women who underwent surgical revision of a synthetic sling (SS) over an 11 year period between 2000 and 2010 inclusive, for the treatment of voiding dysfunction. Voiding dysfunction was defined as a persistently raised post-void residual of >150ml. Patient review included demographics, a comprehensive medical history, all surgical reports and a detailed proforma with details of lower urinary tract symptoms, physical findings and bladder diaries. Variables were compared between methods of sling revision using the Fisher exact test (Freeman–Halton extension) with a 2 by 3 contingency table. Statistical significance is defined as P≤0.05.Results: Sixty-three women underwent SS revision for voiding dysfunction with an overall success rate of 87%. Three types of surgical revision were performed; simple SS division (46/63, 73%), partial excision of SS material (13/63, 21%) and either division or excision but with a concomitant procedure to prevent recurrent SUI (4/63, 6%). Persistent voiding dysfunction following revision in each of the three groups was 5/46 (10.9%), 1/13 (7.7%) and 2/4 (50%) respectively (P=0.09). Subsequent surgery for recurrent SUI in each of the groups was 1/46 (2.2%), 3/13 (23.1%) and 0/4 (0%) respectively (P=0.04).Conclusions: Surgical revision of a SS is an effective treatment for postoperative voiding dysfunction. Both simple division and partial excision of the SS are successful, but simple division carries a lower risk of recurrent SUI. A concomitant SUI procedure at the time of revision may prevent recurrence but may increase the risk of persistent voiding dysfunction.

Anti-phosphatidylserine, anti-cardiolipin, anti-β2 glycoprotein I and anti-prothrombin antibodies in recurrent miscarriage at 8–12 gestational weeks - Corrected Proof

2012-04-20

Abstract: Objective: To investigate the association of antibodies to β2-glycoprotein I (anti-β2GPI), cardiolipin (ACA), phosphatidylserine (anti-PS) and prothrombin (anti-PT) with recurrent spontaneous miscarriage (RSM).Study design: Case–control study involving 277 RSM cases and 288 controls: autoantibody levels were measured by ELISA. Differences between cases and controls were analyzed by nonparametric Mann–Whitney test, and logistic regression was used in analyzing the association of autoantibodies with RSM.Results: Anti-PS IgG, ACA IgM and IgG, and anti-PT IgM were significantly associated with RSM risk, and differential antibody association was noted according to BMI and primary and secondary RSM. Higher prevalence of elevated anti-PS IgG was seen in cases, with the strongest risk above the 99th percentile. For ACA IgM, 28 cases (10.1%) and 5 controls (1.7%) were positive, with increasing OR for increasing cut-off points, which was significant at antibody titers >99th percentile. For ACA IgG, 101 cases (36.5%) and 13 controls (4.5%) were positive, with graded increase in OR for increasing cut-off points, which was significant at titers >90th percentile (maximal at titers >99th percentile). For anti-PT, 23 cases (12.0%) and 9 controls (6.1%) were positive, with increased OR at titers >90th percentile. Regression analyses confirmed the independent association of anti-PS IgG, ACA IgM and IgG with RSM, and significant RSM risk was associated with high anti-PS IgG (P<0.001) and ACA IgM (P<0.001) titers, and a dose-dependent increase in RSM risk was seen with progressively increased ACA IgG titers. No significant association existed between anti-PT IgM and RSM.Conclusion: Elevated ACA IgM and IgG, and anti-PS IgG antibodies are positively associated with RSM.

A rare confounder in a case of ovarian torsion - Corrected Proof

Adam Cristaudo, Luke Waldrip, Alex Mowat, Anantha Ramanathan — 2012-04-20

We report a 26-year-old woman who presented to the Emergency Department in late 2011, with severe right iliac fossa pain, nausea and vomiting after two weeks of mild generalised abdominal pain. There was no history of fever, urinary symptoms, vaginal bleeding or discharge, or change in bowel habit.

Body mass index is negatively correlated with the response to controlled ovarian stimulation but does not influence oocyte morphology in ICSI cycles - Corrected Proof

2012-04-19

Abstract: Objective: To investigate whether or not body mass index (BMI) is associated with oocyte dysmorphisms.Study design: This retrospective study enrolled 1105 patients undergoing intracytoplasmic sperm injection (ICSI). The correlation between BMI and the response to controlled ovarian stimulation (COS) and ICSI outcomes was analysed. Oocyte morphology was determined in metaphase II (MII) oocytes retrieved from all cycles. The influence of BMI on the odds of having oocyte dysmorphism was also studied.Results: A negative correlation was found between BMI and the number of oocytes retrieved, MII oocytes, oocytes injected, embryos obtained, high-quality embryos and oocyte recovery rate. In addition, a trend towards a negative correlation between BMI and implantation rate was observed. However, BMI did not influence oocyte dysmorphisms.Conclusions: A negative correlation was found between BMI and the response to COS, and a trend towards a negative correlation was observed between BMI and implantation rate in the ICSI cycles. However, oocyte dysmorphisms were not influenced by BMI and, therefore, do not account for the reduced ICSI outcomes.

Sexuality, pre-conception counseling and urological management of pregnancy for young women with spina bifida - Corrected Proof

2012-04-19

Abstract: A great number of newborns with spina bifida now survive with a growing life expectancy. Support with regard to sexual issues is essential in the management of adolescents with spina bifida, who require specific knowledge of sexual problems related to their disability. Women with spina bifida are usually fertile and need pre-conception counseling. Furthermore, compared to healthy women they have a higher chance of conceiving a child with spina bifida, so they are treated with periconceptional folic acid supplements. In addition pregnancies in women with spina bifida require adequate management of secondary conditions, mainly urological issues, which are exacerbated during pregnancy. This article gives an overview of sexual education, sex functioning and sexual activity among adolescents with spina bifida. Moreover, we aim to support young women with spina bifida, providing pre-conception counseling and practical guidelines essential for the urological management of their pregnancy.

Rectosigmoid deep infiltrating endometriosis and ureteral involvement with loss of renal function - Corrected Proof

2012-04-16

Abstract: Endometriosis is a complex disease with unclear pathogenesis, defined as the presence of endometrial tissue (glands and stroma) outside its usual location in the uterine cavity. Ureteral involvement is rare, with an estimated frequency of 10–14% in cases of deep endometriosis with nodules of 3cm or larger. An important complication of ureteral involvement is asymptomatic loss of renal function. In a patient with asymptomatic renal failure the relevance of extrinsic ureteral involvement by deep endometriosis has been taken to account.Case report: A 32-year-old nulliparous woman presented with chronic pelvic pain associated with severe dysmenorrhea, dyspareunia and digestive problems including diarrhea, occasional constipation and rectal bleeding. She reported no urological symptoms. Magnetic resonance imaging (MRI) identified a 4cm nodule in the recto-vaginal septum, compressing and infiltrating the rectal wall, and chronic left hydronephrosis. Isotope renogram revealed 91% function in the right kidney and 9% in the left kidney. A multidisciplinary surgical team including consultants from the departments of digestive surgery and urology assessed the patient. The treatment recommended was a joint approach of laparoscopic surgery to perform adhesiolysis, ureterolysis, freeing of the uterus and appendages, resection of the rectovaginal septum nodule, and left nephrectomy.Comment: Diagnosis and treatment of deep endometriosis should be performed in specialized centers and in the context of multidisciplinary collaboration. We must be aware of the potential risk of ureteral involvement and the asymptomatic loss of renal function in any patient with endometriosis nodules of 3cm or larger.

A potency of plasminogen activation system in long-term prognosis of endometrial cancer: a pilot study - Corrected Proof

2012-04-16

Abstract: Objective: Plasminogen activators released from cancer cells lead to degradation of basement membrane proteins and extracellular matrix, and facilitate cancer cell invasion into surrounding tissues and the blood stream. The aim of this study was to evaluate a complex tissue immunohistochemical expression of the plasminogen activation system – urokinase-type plasminogen activator (uPA) and its receptor (uPAR), tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor (PAI)-1 – in endometrial cancer, and to correlate obtained results with disease progression and course.Study design: The study group was composed of 100 patients classified in three sub-groups according to the FIGO 2010 tumour stratification (G1=70, G2=19, G3=11). Expression of uPA, tPA, uPAR and PAI-1 was examined by means of immunohistochemical staining.Results: Immunohistochemical expressions of all the studied markers did not differ between G1 and G2 patients. However, G3 subjects were found to have a significantly lower expression of uPA, PAI-1 and tPA. In addition, the patients who survived were found to be PAI-1 negative, while study participants with an unfavourable disease course were PAI-1 positive.Conclusions: A significantly higher immunohistochemical expression of PAI-1 was found to correlate with shorter relapse-free and overall survival in patients classified as stages IB and II of endometrial cancer.

Pre-emptive analgesia by nerve stimulator guided pudendal nerve block for posterior colpoperineorrhaphy - Corrected Proof

Mohamed Taha Ismail, Nagat S. Elshmaa — 2012-04-16

Abstract: Objective: To assess the effect of pre-emptive analgesia by bilateral nerve stimulator-guided pudendal nerve block (PNB) on pain intensity and consumption of analgesics following posterior colpoperineorrhaphy.Study design: Prospective randomized observer-blinded study. The study included 130 patients who were scheduled to undergo posterior colpoperineorrhaphy under general anesthesia (GA). They were invited to enroll in the study during the period from October 2009 to August 2011 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 65 patients each: GA alone or GA combined with pre-emptive nerve stimulator-guided PNB with 10mL of 0.25% bupivacaine in each side. The primary outcome measures were VAS pain scores and postoperative analgesic consumption.Results: Postoperative average VAS pain scores, IM pethidine consumption and IV paracetamol consumption during the first 24h; were highly significantly lower in the PNB group compared to the GA alone group. This technique was also associated with a significantly higher overall patient satisfaction compared to GA alone, without obvious side effects.Conclusion: Pre-emptive analgesia by bilateral nerve stimulator-guided PNB is a simple and useful technique that when combined with GA was found to substantially reduce postoperative pain and consumption of analgesics during the first 24h postoperatively, and shorten the time to return to normal activities compared to GA alone for patients undergoing posterior colpoperineorrhaphy. The use of PNB was also associated with a high overall patient satisfaction. Thus, the results of the present study may recommend the use of nerve stimulator-guided PNB in posterior colpoperineorrhaphy patients.

Risk factors associated with nicotine dependence in a sample of Romanian pregnant smokers - Corrected Proof

Cristian I. Meghea, Ioana A. Rus, Diana Rus — 2012-04-16

Abstract: Objectives: To fill the gap in assessing nicotine dependence during pregnancy in an unexplored population in Central and Eastern Europe and to analyze the associations of maternal characteristics and prenatal risk factors with moderate-heavy nicotine dependence among pregnant smokers.Study design: A questionnaire was applied to pregnant smokers in Romania to assess nicotine dependence and other related risks poorly documented in Central and Eastern Europe. The response rate was >80% and the valid sample included 137 pregnant smokers. Descriptive statistics and logistic regressions were used to assess nicotine dependence and to analyze the associations of maternal characteristic and prenatal risk factors with moderate-heavy nicotine dependence.Results: Approximately 43% of the pregnant smokers in our sample (59 of 137) had moderate to heavy nicotine dependence. Depressive symptoms were associated with moderate-heavy nicotine dependence among pregnant smokers (OR=3.07, p<0.05). Women carrying an unwanted pregnancy had higher odds of moderate-heavy nicotine dependence (OR=2.59, p<0.05) compared to other pregnant women. High stress, lack of social support, and socioeconomic status were not associated with nicotine dependence.Conclusions: A large proportion of women had moderate-heavy nicotine dependence in a sample of Romanian pregnant smokers. The more dependent pregnant smokers were more likely to have depressive symptoms. Prenatal care should include brief nicotine dependence assessments and mental health screening and referrals for pregnant women who smoke. Special and intensive efforts, including psychosocial components, may be needed for the nicotine dependent pregnant smokers.

Are enemas given before cesarean section useful? A prospective randomized controlled study - Corrected Proof

Samuel Lurie, Carolina Baider, Hagit Glickman, Abraham Golan, Oscar Sadan — 2012-04-16

Abstract: Objective: To assess the effect of preoperative enemas on the postoperative recovery of bowel habits in women undergoing elective cesarean section.Study design: A prospective randomized controlled study with a standard two-group parallel design. The study was registered at the Protocol Registration System of the National Institute of Health (NCT00391599). With an α of 0.05, and a β of 0.1 (power of 90%) 65 participants were required in each group. The inclusion criteria were elective cesarean section and no history of previous abdominal operations except for cesarean delivery. Randomization was done by random number generator. The study group (n=65) was given a Fleet enema and the controls (n=65) had no preoperative intestinal preparation. The primary outcome measures were postoperative return of bowel sounds, gas passage and first spontaneous feces. Care givers and those assessing the outcomes were blinded to group assignment.Results: On postoperative day 1, among women who had a preoperative enema, 35.3% had bowel sounds, 47.2% had gas passage and 1.5% had spontaneous feces, compared to 47.2%, 52.8%, and 10.8%, respectively, among those who had no enema. The differences were not statistically significant.Conclusion: As we could not demonstrate any benefit for preoperative enema, we recommend against routine use of preoperative enema prior to elective cesarean delivery.

Impact of body mass index versus physical activity and calorie intake on assisted reproduction outcomes - Corrected Proof

2012-04-16

Abstract: Objective: To measure the effect of body mass index (BMI) versus calorie intake and physical activity (PA) on the outcomes of assisted reproductive technologies (ART).Study design: A prospective study was performed on 236 infertile women who underwent in vitro fertilization. BMI, level of PA and calorie intake were assessed at study entry, and associations between these variables and ART outcomes were analyzed. Participants were divided into four groups based on BMI and PA: normal BMI/inactive, normal BMI/active, overweight/inactive and overweight/active.Results: BMI, adjusted for age, level of PA, calorie intake and aetiology of infertility, was not associated with the number of oocytes retrieved, fertilization rate, cleavage rate, number of embryos, number of high-quality embryos or pregnancy rate. For women aged <36years, the number of oocytes retrieved and the number of embryos decreased with increasing BMI, independent of calorie intake and PA. The fertilization rate, cleavage rate, number of high-quality embryos and pregnancy rate were not associated with BMI. The number of oocytes retrieved was significantly higher in women of normal weight compared with overweight women, regardless of the level of PA.Conclusions: Age has a strong negative effect on ART parameters. Increased BMI, independent of calorie intake and PA, has an adverse effect on the number of oocytes retrieved in women aged <36years, but does not affect the number of high-quality embryos or the success of the treatment cycle.

Use of laparoscopy in unexplained infertility - Corrected Proof

C. Bonneau, O. Chanelles, C. Sifer, C. Poncelet — 2012-04-16

Abstract: Objective: The use of laparoscopy in unexplained infertility work-up is still a subject of debate, although laparoscopy remains the gold standard for diagnosis and treatment of several pelvic pathologies. The objective of this study was to assess the rates and types of pelvic pathologies observed during diagnostic laparoscopy, and the pregnancy rate in couples with unexplained infertility following laparoscopy.Study design: Prospective study, from November 2003 to October 2009, including 114 infertile, spontaneously ovulating women with normal clinical examination, ovarian reserve assessment, pelvic ultrasound scan and patent tubes on hysterosalpingography. Semen analyses were normal according to the World Health Organization criteria. After three cycles of ovulation induction with or without intra-uterine insemination and no pregnancy, women were referred for diagnostic laparoscopy.Results: Laparoscopy revealed pelvic pathology in 95 patients. Endometriosis, pelvic adhesions and tubal disease were observed and treated in 72, 46 and 24 patients, respectively. Following laparoscopy, bilateral and unilateral tubal patencies were observed in 107 and five patients, respectively. Pregnancy was observed in 77 out of 102 patients who tried to conceive after surgery, 35 of whom conceived using their own tubes.Conclusion: Diagnostic laparoscopy should be strongly considered in unexplained infertility work-up, and tubal efficiency should not be underestimated.

Selective salpingography: preliminary experience of an office operative option for proximal tubal recanalization - Corrected Proof

2012-04-16

Abstract: Objective: To evaluate treatment efficacy and patient acceptability of the new Radiographic Tubal Assessment Set (RTAS) (Cook Ireland Ltd., Limerick, Ireland) for selective salpingography (SSG).Study design: 33 women, between 23 and 38 years old, referred to the Fertility Centre of the Department of Obstetrics, Gynecology and Reproductive Science, Second University of Naples, for sterility problems, underwent an office operative SSG with the RTAS. Of the 33 women, 12 had bilateral tubal obstruction (Group A) and 21 had unilateral tubal obstruction (Group B). Patients who did not regain tubal patency were referred for laparoscopic surgery. To verify patient acceptability, a visual analogue score (VAS 1-10) of pain was completed immediately after the procedure.Results: From a total of 45 obstructed fallopian tubes, 34 were recanalized, giving a success rate for the procedure of 75.6% (p<0.001). Nine patients with bilateral tubal obstruction (Group A) had the tubes recanalized and five obtained a spontaneous pregnancy. Sixteen patients with monolateral tubal obstruction (Group B) had the tubes recanalized and nine obtained a spontaneous pregnancy. A total of seven patients were sent for operative laparoscopy: four of them had the tubes recanalized and two obtained a spontaneous pregnancy. One patient was lost to follow-up. The evaluation of the level of pain felt during the procedure on the 10cm VAS showed mean pelvic pain 2.9±2.2, and an incidence of no discomfort±low pain significantly higher than moderate±severe pain (p<0.0001).Conclusion: The RTAS can be considered a safe and effective tool to perform this office operative procedure for tubal recanalization, with a high acceptability for the patient. The “see and treat” approach in patients with proximal tubal obstruction (PTO) suggests for the future the use of this device under sonographic guidance, taking into account accurate patient selection.

A randomized controlled trial comparing three vaginal kits of single-incision mini-slings for stress urinary incontinence: surgical data - Corrected Proof

2012-04-16

Abstract: Objective: Single-incision mini-slings (SIMS) are new minimally invasive devices used for female stress urinary incontinence (SUI). To date, several SIMS are available, but few and uncontrolled comparative data have assessed their safety and feasibility. The aim of the present clinical study was to compare three different SIMS in an ambulatory setting.Study design: One hundred and twenty patients with SUI were randomized to receive three SIMS: Ajust®, MiniArc®, and TVT Secur System®. Surgical data were compared.Results: Significantly (P<0.05) lower surgical difficulty and higher patient satisfaction were detected in the MiniArc® group when compared to the Ajust® and TVT Secur System® groups. A significantly (P<0.05) higher feasibility under local anesthesia and in ambulatory setting was also detected for the MiniArc® group. The overall complication rate was significantly (P<0.05) lower in the MiniArc® group than in the TVT Secur System® group.Conclusions: MiniArc® is simpler to insert under local anesthesia and in an ambulatory setting. It is safer than the TVT Secur System®, and is related to higher patient satisfaction.

Antibiotic prophylaxis in diagnostic hysteroscopy: is it necessary or not? - Corrected Proof

O. Gregoriou, P. Bakas, C. Grigoriadis, M. Creatsa, C. Sofoudis, G. Creatsas — 2012-04-13

Abstract: Objective: Surgical site infection remains the most common complication of surgery. Up to 5% of patients undergoing operative procedures will develop an infection leading to a prolonged hospital stay with increased cost. On the other hand the indiscriminate use of antibiotics has been associated with the development of antibiotic-resistant bacteria. The aim of this study was to examine the effect of antibiotic prophylaxis in cases of diagnostic hysteroscopy.Study design: This was an eight-year randomized controlled clinical trial. The study group consisted of 364 women who underwent diagnostic hysteroscopy because of menometrorrhagia, post-menopausal vaginal bleeding, ultrasound findings of increased thickness of the endometrium, or as a routine examination prior to a first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.Results: Of the 364 women who underwent diagnostic hysteroscopy during this eight-year study period, 176 received antibiotic prophylaxis whereas 188 did not. There were no significant differences in the prevalence of postoperative infections observed between women who received antibiotic prophylaxis (0.57%) and those who underwent the procedure without prophylaxis (0.53%).Conclusion: Given the very low risk of infection after diagnostic hysteroscopy and lack of evidence of efficacy, routine antibiotic prophylaxis is not recommended.

Polycystic ovary syndrome: double click and right check. What do patients learn from the Internet about PCOS? - Corrected Proof

Athanasios Mousiolis, Lina Michala, Aris Antsaklis — 2012-04-12

Abstract: Objective: To identify the websites most visited by patients regarding polycystic ovary syndrome (PCOS), and to evaluate the quality of information provided by these websites.Study design: We sought data regarding the popularity of sites providing information about PCOS regardless of the way the visitors reached the site. We then scrutinized the top sites for predefined quality check points to evaluate the quality of information provided, including Health on Net Foundation (HON) accreditation. Finally, we searched for the expansion of these sites in social networks (Facebook and Twitter).Results: Of the top 15 sites, 8 were HONcode certified. The mean performance of content presence for all sites was 7.33 (min=4, max=10, SD=1.633). There was a moderate correlation of higher performance score with HON accreditation (R: 0.535, p<0.05). Several sites have expanded in social media. None of the high-score sites has a page dedicated to PCOS.Conclusions: There exists a lack of HON accreditation in many sites and a wide variability in the quality of the information provided. In some cases, key elements of content, necessary for complete appreciation of PCOS, are missing. Official and high authority healthcare organisms should introduce themselves in the social media world.

Changes in detrusor muscle oxygenation during detrusor overactivity contractions - Corrected Proof

2012-04-12

Abstract: Objective: To investigate changes in the oxygenated and deoxygenated haemoglobin (Hb) of the bladder wall during voluntary and involuntary detrusor contractions.Study design: Women with lower urinary tract symptoms were recruited from a urodynamics clinic. Near infra-red spectroscopy, a non-invasive optical technique which monitors changes in tissue oxygenation, was used to measure oxygenated and deoxygenated haemoglobin simultaneously while the women underwent urodynamics. All data were compared using paired sample t-test.Results: Fifty-five women with a mean age of 52 years were enrolled into the study. In the 23 women with detrusor overactivity (15 with isolated detrusor overactivity and 8 with mixed urinary incontinence) there was a statistically significant rise in deoxygenated Hb during involuntary detrusor contractions at maximum detrusor pressure compared to the start of filling (p=0.02). There was no statistically significant change between Hb parameters measured at the start of the filling phase and those measured during voluntary detrusor contraction at pdetQmax (detrusor pressure at maximum flow rate). The mean detrusor pressure measured during voiding, however, was significantly higher than the maximum pressure during involuntary detrusor contractions (p=0.03).Conclusion: There is a significant rise in the deoxygenated Hb in the detrusor muscle during detrusor overactivity, which is not seen during voiding even when the pdetQmax was higher than the peak detrusor pressure during involuntary contractions. These interesting changes in detrusor muscle oxygenation during involuntary detrusor contraction need to be explored further to assess if deoxygenation plays a role in the pathogenesis of detrusor overactivity.

Does 45,X/46,XX mosaicism with 6–28% of aneuploidy affect the outcomes of IVF or ICSI? - Corrected Proof

2012-04-10

Abstract: Objective: Several studies have shown an increased frequency of chromosomal aberrations in female partners of couples examined prior to intracytoplasmic sperm injection (ICSI). A retrospective cohort study was performed to determine whether 45,X/46,XX mosaicism affects the outcomes of in vitro fertilization (IVF) or ICSI.Study design: Forty-six women with a 45,X/46,XX karyotype with 6–28% of aneuploidy were compared with 59 control women (46,XX), matched for age, from the female population who underwent IVF or ICSI between 1 January 1996 and 31 December 2006 at the Reproductive Medicine Unit at Brest University Hospital. The outcomes of 254 treatment cycles were compared according to patient karyotype.Results: No difference was found in the number of retrieved oocytes (8.9±5.5 vs 8.5±4.7; p=0.56) or the number of mature oocytes (7.4±4.7 vs 6.9±4.2; p=0.49) between the 45,X/46,XX group and the 46,XX group, respectively. Fertilization rates did not differ between the groups for either IVF or ICSI. In addition, no difference was found in the pregnancy rate by cycle (17.4% vs 18.7%, respectively; p=0.87). The percentage of first-trimester miscarriages was similar in both groups (13.6% vs 12.5%, respectively; p=0.51).Conclusion: 45,X/46,XX mosaicism with 6–28% of aneuploidy has no adverse effect on the outcomes of IVF or ICSI among women referred to assisted reproductive technologies.

Diagnostic strategies for endometrial cancer in women with postmenopausal bleeding: cost-effectiveness of individualized strategies - Corrected Proof

2012-04-06

Abstract: Objective: To evaluate the cost-effectiveness of diagnostic strategies incorporating the diagnostic value of patient characteristics for endometrial carcinoma using prediction models.Study design: A decision analytic model was created to compare four diagnostic strategies for women with postmenopausal bleeding: the main outcome measures were 5 year survival, costs, and cost-effectiveness of three model based strategies compared to the strategy reflecting current practice.Results: A strategy selecting women for endometrial biopsy based on their history only, dominated all other strategies (more effective, less cost). In a clinical scenario where transvaginal sonography (TVS) was assumed to be an integral part of the consultation without additional costs, a strategy selecting high-risk women for TVS became the most cost-effective strategy.Conclusions: Strategies taking into account the individual probability based on a prognostic model are less costly than the currently applied strategy for a similar effectiveness. The most cost-effective strategy depends on the clinical setting: in areas where TVS is performed by the consulting gynecologist without extra costs, selective TVS based on history is the most cost-effective strategy. When TVS is not readily available and therefore incurs extra costs, a risk selection based on patient characteristics is most cost-effective.

Effects of immunosuppression by cyclosporine A on allogenic uterine transplant in the rat - Corrected Proof

Klaus Groth, Shamima N. Akhi, Johan Mölne, Caiza A. Wranning, Mats Brännström — 2012-04-06

Abstract: Objective(s): : Research on uterine transplantation (UTx) is conducted in preparation for its introduction in the human as a treatment for absolute uterine factor infertility. A major area of research in experimental animals is to ascertain that immunosuppressants that will be used at UTx do not negatively affect the potential of the uterus to implant an embryo and to carry a pregnancy to term. This study investigates the effects on a uterine transplant in the rat of the calcineurin inhibitor, cyclosporine A (CsA), on uterine morphology and expression patterns of some mediators involved in implantation/inflammation.Study design: : Donor rats were of Brown Norway strain and recipients were of Lewis strain. The uterus was transplanted to an orthotopic site by vascular anastomosis. The recipients were given CsA (10mg/kg) sc once daily or no CsA until they were sacrificed at postoperative day 7. Syngenic transplanted Lewis rats were used as controls. Uteri were analyzed regarding histology, immunohistochemistry against T-cells and mRNA levels of the implantation/inflammation-related markers leukaemia inhibitory factor (LIF), galectin-1, CD200, interleukin (IL)-1α, and IL-15.Result(s): : There was pronounced inflammation with abundance of CD8-lymphocytes in uterine grafts of non-CsA-treated animals and only mild inflammation in treated animals. The uterine mRNA levels of IL-1α were decreased after CsA in comparison to uteri of non-treated transplanted animals. The mRNA levels of galectin-1 were decreased in the rejected uteri and were higher in the CsA-treated. The levels of mRNA of IL-15 were lower in the syngenic transplanted group compared to the CsA-treated transplanted. There was no difference between the groups concerning mRNA levels of CD200, or LIF, with wide variation of the levels of the two latter mediators in all groups.Conclusion(s): : Cyclosporine A suppresses rejection of an allogenic rat uterine transplant, with normalization of mRNA levels of the proinflammatory cytokine IL-1α and the glycan-binding protein galectin-1.

Diagnosing vaginal infections through measurement of biogenic amines by ion mobility spectrometry - Corrected Proof

Jack D. Sobel, Zeev Karpas, Avraham Lorber — 2012-04-05

Abstract: Objective: To compare diagnosis of bacterial vaginosis according to the Amsel criteria with measurement by ion mobility spectrometry (IMS) of the biogenic amines that are present in vaginal discharge fluid.Study design: Duplicate samples of vaginal fluid were collected from 115 unselected and consecutive patients in a vaginitis clinic in Detroit. All samples were evaluated using Amsel criteria and the results were compared with the diagnosis based on the IMS results.Results: The incidence rate of vaginal infections was assessed on the basis of both tests and the frequency of BV was found to be 17.4%. The sensitivity and specificity for bacterial vaginosis diagnosis using IMS determination were 95.5% and 98.9%, respectively, with an accuracy of 94.4%.Conclusions: The results show that IMS may be used to rapidly diagnose this common vaginal infection with high accuracy.

Pitfalls in diagnosis and management of distal vaginal agenesis: 10-year experience at a single centre - Corrected Proof

M.G. Ugur, O. Balat, E. Ozturk, M. Bekerecioglu, E. Dikensoy — 2012-04-04

Abstract: Objective: To discuss common pitfalls in diagnosis and management of distal vaginal agenesis, and summarize 10 years of experience among 11 patients using an interposition full-thickness graft and fibrin glue.Study design: Eleven patients with distal vaginal agenesis were evaluated and managed with an interposition full-thickness graft to bridge the gap between the upper vagina and the introitus. Associated renal abnormalities and complications including infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, vaginal stricture and graft uptake were all investigated.Results: The mean age of the patients was 12.91 (standard deviation 1.22) years. All patients had primary amenorrhoea, cryptomenorrhea, and cyclical or constant pelvic pain. None of the patients had associated urological abnormalities, and there were no cases of infection, total lack of skin graft take, stress urinary incontinence, partial graft loss or vaginal stricture. Graft uptake was 100% in 10 of the 11 patients. Four patients have subsequently married and report a satisfactory sex life.Conclusion: Accurate diagnosis of distal vaginal agenesis and careful pre-operative set-up, including evaluation of associated anomalies, bowel preparation, available vaginal stents and a multidisciplinary approach for the potential need for grafts, may be key to success.

Epidemiology of hirsutism among women of reproductive age in the community: a simplified scoring system - Uncorrected Proof

Rong Li, Jie Qiao, Dongzi Yang, Shangwei Li, Shulan Lu, Xiaoke Wu, Zhaolian Wei — 2012-04-03

Abstract: Objective: The purpose of our research was to generate large sample evidence for the clinical diagnostic criteria of hirsutism and to simplify the modified Ferriman-Galwey (mF-G) scoring system for Asian women.Study design: This study was a large-scale, cross-sectional epidemiologic investigation conducted in 10 provinces of China. A total of 10,120 reproductive-age women in the community were involved in using the mF-G scoring system to evaluate hirsutism.Results: Of the participants, 95.5% had an mF-G score <5. The strongest contributors to the nine mF-G positions were upper lip, thighs, and lower abdomen. If the cut-off value was set at 2 for these 3 areas, the area under the ROC curve was 0.987 (95% CI 0.983–0.992), which had a sensitivity of 98.7% and a specificity 91.0%. The percentage of hirsutism (mF-G score >4) and the average mF-G score decreased with advancing age.Conclusions: An mF-G scoring >4 can be used to diagnose hirsutism in this population. The results also suggest that hair growth involving the upper lip, thighs, and lower abdomen with scores >2 can be used to diagnose hirsutism in women in the community.

Insulin-like growth factor-II and heparin are anti-apoptotic survival factors in human villous cytotrophoblast - Corrected Proof

Frank A. Hills, Huseyin Mehmet, Mark H. Sullivan — 2012-03-30

Abstract: Objective: This study aimed to determine the effects of insulin-like growth factors (IGF-I and IGF-II), heparin, aspirin and vitamin C on the proliferation and apoptosis of human villous cytotrophoblast from first trimester and term placentae.Study design: Villous cytotrophoblast cells were isolated from uncomplicated first trimester (n=12) and term placental tissues (n=12) using negative immunoselection with an antibody to HLA class I antigens. Cells were incubated with IGF-I, IGF-II, heparin, aspirin and vitamin C either alone, or in combination with either TNF-α/IFN-γ or staurosporine. Proliferation was determined by measurement of Ki67 expression using immunocytochemistry. Trophoblast apoptosis was determined by TUNEL staining. Finally RT-PCR was carried out to identify IGF-binding insulin receptor isoforms. Data were expressed as means±SEM. One way analysis of variance (ANOVA) with Bonferroni correction was used to determine if differences between groups were statistically significant.Results: Following negative immunoselection >98% of cells were positively stained for cytokeratin 7, a marker for cytotrophoblasts, and <1% were vimentin positive. First trimester and term trophoblasts underwent spontaneous apoptosis which was inhibited by approximately 50% in the presence of IGF-II or heparin. Apoptosis was significantly increased following incubation with a combination of TNF-α and IFN-γ or staurosporine. Apoptosis was decreased to basal levels following coincubation with IGF-II or heparin. Incubation with IGFs or heparin resulted in a small, but significant increase in Ki67 expression. Insulin receptor isoform A, which binds IGF-II with high affinity, was present in all trophoblast samples tested.Conclusion: These results suggest that heparin and IGF-II, but not IGF-I are important regulators of villous cytotrophoblast survival in early and late pregnancy.

Association of pre-eclampsia with or without superimposed chronic hypertension in pregnant women with the risk of congenital abnormalities in their offspring: a population-based case–control study - Corrected Proof

Ferenc Bánhidy, Maria Szilasi, Andrew E. Czeizel — 2012-03-29

Abstract: Objective: To investigate the association of pre-eclampsia (PE) or PE with superimposed chronic hypertension (PE+SCH) in pregnant women with the risk of various structural birth defects (i.e. congenital abnormalities) in their offspring.Study design: A population-based case–control study using the Hungarian Case–Control Surveillance of Congenital Abnormalities data set (1980–1996), including 22,843 cases with congenital abnormalities and 38,151 matched controls without any congenital abnormalities. The incidence of PE and PE+SCH was compared in women who had offspring with congenital abnormalities (cases) and women who had offspring without any congenital abnormalities (controls).Results: The incidence of PE was examined in 585 cases and 1017 controls, and the incidence of PE+SCH was examined in 154 cases and 269 controls. None of the 25 studied types of congenital abnormality was found to be more likely among the offspring of women with PE. However, the risks of renal dysgenesis [odds ratio (OR) 4.7, 95% confidence interval (CI) 1.7–12.8], esophageal atresia/stenosis (OR 4.6, 95% CI 1.8–12.2) and rectal/anal stenosis (OR 3.7, 95% CI 1.6–8.5) were higher in the offspring of pregnant women with PE+SCH.Conclusions: PE in pregnant women was not associated with a higher risk of any congenital abnormalities in their offspring, but PE+SCH was associated with a higher risk of renal dysgenesis, esophageal atresia/stenosis and rectal/anal stenosis. These findings need confirmation in other studies.

Pinworms in menstrual blood - Corrected Proof

Savita Rani Singhal, Anshu Paul, Pushpa Dahiya — 2012-03-29

We report an unusual case of enterobius vermicularis adult live worms recovered from the menstrual blood. A 35-year-old multiparous woman presented with intense vulval itching and a four-month history of passage of worms in the menstrual blood. There was no history of passage of worms in the intermenstrual period or any perianal itching. Her 16-year-old daughter had had similar complaints for two months. The family had changed their residence four months ago. Speculum examination revealed a healthy cervix and vagina with a slight non-offensive vaginal discharge. There was no evidence of any worms or eggs in the fornices, vagina or perianal area. A high vaginal swab was taken and sent for any evidence of any pathogenic organisms or ova. There was no palpable mass. The patient was asked to collect her menstrual blood in the next menses; this was then sent for any evidence of parasites. Microscopic examination confirmed the presence of larva of enterobius vermicularis in the menstrual blood. The patient was then treated with mebendazole, after which she became asymptomatic. Her daughter, who was unmarried, was also advised to take mebendazole though she never attended the hospital, but her mother reported that she was also relieved.

Best predictors of survival outcome after tertiary cytoreduction in patients with recurrent platinum-sensitive epithelial ovarian cancer - Corrected Proof

2012-03-29

Abstract: Objective: To evaluate the efficacy of tertiary cytoreduction (TCR) on survival and to determine prognostic factors which may influence surgical and survival outcome.Study design: Twenty-three consecutive patients who had recurrent platinum-sensitive epithelial ovarian cancer and underwent TCR between January 1999 and January 2011 were evaluated. Factors which impact on TCR outcome and survival were determined by statistical analysis.Results: TCR was optimal (< 1cm residual tumor) in 15 of the 23 patients (65.2%) and suboptimal in 8 patients (34.8%). None of the clinicopathologic factors was associated with TCR outcome. On the contrary, TCR outcome (optimal vs suboptimal) was independently associated with survival in univariate analysis (P=0.018).Conclusion: There is not a good predictor of TCR outcome but TCR seems to be beneficial for patients in whom optimal surgery can be achieved. Therefore, preoperative assessment of patients and weighing the potential survival benefit against potential surgical risks are very important for patient selection.

Association of polycystic ovary syndrome susceptibility single nucleotide polymorphism rs2479106 and PCOS in Caucasian patients with PCOS or hirsutism as referral diagnosis - Corrected Proof

2012-03-29

Abstract: Context: Polycystic ovary syndrome (PCOS) is the most common endocrine disease among premenopausal women. A recent study found association between three single nucleotide polymorphisms (SNPs) and PCOS in a cohort of Han Chinese women.Objective: To investigate the association between rs13405728 (LHCGR gene), rs13429458 (THADA gene) and rs2479106 (DENND1A gene), PCOS, hirsutism and metabolic and hormonal parameters in a well characterized cohort of Caucasian patients of Danish descendant with PCOS or hirsutism.Study design: Patients underwent clinical examination, hormone analyses, oral glucose tolerance test and transvaginal ultrasound. Genetic variation was tested using allelic discrimination by real-time PCR.Patients: 268 patients referred to The Department of Endocrinology, Odense University Hospital, Denmark with PCOS or hirsutism between 1997 and 2011. Two hundred and forty-eight healthy females were included as controls.Results: Genotype distributions and allele frequencies of rs13405728, rs13429458, and rs2479106 were comparable in patients and controls. The rs2479106 G allele was associated with a decreased PCOS susceptibility. None of the SNPs were associated with hirsutism or increased metabolic parameters.Conclusions: The rs2479106 G allele was associated with decreased PCOS susceptibility, thus confirming previously reported findings of association between rs2479106 and PCOS. Metabolic and hormonal parameters were comparable between genotypes of rs13405728 and rs2479106.

Misdiagnosis of rodenticide poisoning as ectopic pregnancy: a case report - Corrected Proof

Lin Wu, Xiaohui Lu, Rutie Yin, Donghao Lu — 2012-03-29

We report a rare case of rodenticide poisoning misdiagnosed as ectopic pregnancy. An 18-year-old woman was referred to the Emergency Department due to vaginal bleeding and abdominal pain. She was unmarried but sexually active. She had irregular menstrual intervals of 30–60 days, and her last period was 45 days ago. She had had irregular vaginal bleeding for 10 days, and painless hematuria for 5 days. Four hours before admission she started to experience abdominal pain and coffee-ground vomiting. A urine pregnancy test in the local hospital was positive, and severe dysfunction of coagulation was found. She was given four units of packed red cells and transferred to our hospital because of hypovolemic shock. Physical examination showed that there were large areas of subcutaneous ecchymosis and blood in her mouth, nose and vagina. Her abdomen appeared very distended with tenderness but without rebound tenderness. Bimanual pelvic examination was unsatisfactory because of her non-cooperation and abdominal distention. A full blood count revealed hemoglobin of 63g/L and platelets of 159×109/L. Emergency ultrasound showed a huge volume of intraperitoneal fluid, and an unevenly echoic mass with a diameter of 5cm located in the right side of the pelvic cavity, which suggested an ectopic pregnancy or blood clot. Ectopic pregnancy with massive hemorrhage was strongly suspected. Rupture of a corpus luteum was also considered, given that there could be false positive in the previous urine pregnancy test. Emergency laparotomy was performed immediately while the coagulation test and serum HCG test were ongoing. During surgery, surprisingly, we found normal uterus, ovaries and tubes, but only a large amount of blood in the intestines and approximately 400ml of blood in the pelvis.

Peritumoral stromal remodeling, pattern of invasion and expression of c-met/HGF in advanced squamous cell carcinoma of the cervix uteri, FIGO stages III and IV - Corrected Proof

L.-C. Horn, N. Hommel, U. Roschlau, K. Bilek, B. Hentschel, J. Einenkel — 2012-03-28

Abstract: Objective: Different patterns of invasion (PIs) have prognostic impact in several types of cancer and are associated with different grades of peritumoral stromal remodeling, characterized by the desmoplastic stromal response (DSR). One key regulator influencing cellular motility and peritumoral stromal response is c-met/HGF. This study evaluates the association between different PI, peritumoral DSR and its correlation to the expression of c-met/HGF in squamous cell carcinomas of the uterine cervix (CX).Study design: 131 advanced stage CX (FIGO III/IV) were re-evaluated histologically regarding PI, using a two-level scoring system. The tumor grows in solid cords/trabeculae in finger-like PI and in very small groups or single cells in spray-like PI. DSR was categorized as none/weak and moderate/strong. The tumors were stained with antibodies against c-met and HGF. The staining of >30% of tumor cells was defined as overexpression. The PI was correlated to the prognostic outcome, different categories of DSR and expression status of c-met and HGF.Results: 66.4% of the tumors showed a finger-like, and 33.6% a spray-like PI. The spray-like PI showed a reduced two-year overall survival when compared to the finger-like PI (14.0% vs. 29.1%, respectively; p=0.012), and was associated with moderate/strong DSR. The majority of the tumors showed overexpression of c-met (85.4%) and HGF (74.8%). There was no correlation between the expression status of c-met/HGF and the FIGO stage, peritumoral DSR or the prognostic outcome.Conclusions: Spray-like PI is of prognostic impact in cervical carcinoma FIGO III/IV and is associated with strong peritumoral stromal remodeling. There is no prognostic impact of the immunohistochemical expression of c-met/HGF in advanced stage cervical carcinomas.

Comparison of transforming growth factor β1 concentrations in the ovaries of rats stimulated by human menopausal gonadotropin or recombinant follicle-stimulating hormone - Corrected Proof

2012-03-27

Abstract: Objective: To compare the effects of human menopausal gonadotropins (hMG) and recombinant follicle stimulating hormone (rFSH) on transforming growth factor (TGF) β1 concentration in the rat ovary.Study design: Twenty-one fertile Wistar-Albino rats were divided into 3 groups of 7. Groups 1, 2 and 3 were injected with saline, hMG or rFSH, respectively, over 5days, after which they underwent ovariectomy. Hematoxylin and eosin (H&E) staining was used for histological examination. TGF β1 staining levels in ovarian stroma, vessel walls, granulosa cells of Graafian follicles and corpus luteum cells were investigated immunohistochemically.Results: On histological examination, the number of smaller antral follicles was higher in the control group, while there were more and larger antral follicles in the hyperstimulated groups. There were statistically significant differences in staining in vessel walls and granulosa cells between the control and stimulated groups. Both stimulation protocols caused an increased TGF β1 concentration in vessel walls, while there was weak staining in granulosa cells in the treatment groups compared to the control group (p<0.05). There were no significant differences in staining scores between the two treatment groups (p>0.05).Conclusions: The effects of two different gonadotropin preparations on TGF β1 concentrations in different localizations in the rat ovaries are comparable. It may be postulated that the luteinizing hormone (LH) content of hMG contributes little or nothing to the TGF β1 mediated angiogenesis.

Euglycaemic ketoacidosis in a patient with gestational diabetes - Corrected Proof

Sudha Darbhamulla, Neil Shah, Paul Bosio — 2012-03-26

Euglycaemic ketoacidosis is well known to endocrinologists, but not common in obstetric practice. Here we describe a rare case of euglycaemic ketoacidosis in a patient with gestational diabetes.

Expression of platelet-derived growth factor-B mRNA during vaginal vs. dermal incisional wound healing in the rabbit - Corrected Proof

2012-03-26

Abstract: Objective: The outcome of pelvic reconstructive surgery is largely dependent on the vaginal wound healing process, but this process has not yet been fully elucidated. Platelet-derived growth factor (PDGF) is an important mediator of the wound healing process in cutaneous tissue. We sought to compare PDGF-B mRNA expression in vaginal versus cutaneous incisional wound healing in a rabbit model.Study design: Bilateral 6mm full-thickness circular segments were excised from the vagina and abdominal skin in 36 New Zealand-White female rabbits. Animals were euthanized sequentially before, on the day of and 4, 7, 10, 14, 21, 28 and 35 days after wounding. Their wounds were evaluated for surface area and PDGF-B mRNA expression using real time PCR.Results: In both tissues PDGF-B mRNA expression increased constantly after wounding, reaching peak levels on day 10, and declined immediately thereafter, reaching minimal values on day 21. In both tissues, the expression of PDGF-B mRNA significantly correlated with the wound closure rate.Conclusion: PDGF-B mRNA expression significantly correlates with incisional vaginal and cutaneous wound closure, suggesting that this factor plays an important role in the wound healing process of both tissues.

The effect of chemotherapy or radiotherapy on thymidine phosphorylase and dihydropyrimidine dehydrogenase expression in cancer of the uterine cervix - Corrected Proof

2012-03-26

Abstract: Objective: Levels of 5-FU metabolic or related enzymes, particularly thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD), have been investigated in various cancer types, including uterine cervical cancer. Intratumoral TP levels have been reported to increase in response to several chemotherapeutic agents or irradiation in both xenografts and clinical studies. In cervical cancer, however, only a few studies about changes in TP and DPD expression associated with cancer treatment have been published. We evaluated the effect of chemotherapy and/or irradiation on TP and DPD expression in cervical squamous cell carcinoma.Study design: Of 27 patients in this study, 12 patients underwent neoadjuvant chemotherapy consisting of nedaplatin, ifosfamide, and/or peplomycin followed by radical surgery, and 15 patients underwent radiotherapy (n=8) or chemoradiotherapy with nedaplatin (n=7) as initial treatment. Tumor specimens were obtained from biopsies acquired before treatment and after administration of chemotherapy (2 weeks after the first and second cycles), and after irradiation with 10Gy, 20Gy, and 30Gy. These specimens were used to measure TP and DPD levels by ELISA.Results: In the 12 patients who received neoadjuvant chemotherapy, intratumoral TP and DPD levels did not change. In contrast, in the 15 patients who underwent radiotherapy or chemoradiotherapy with nedaplatin, TP or DPD expression appeared to be slightly increased or decreased, respectively, after irradiation with 20Gy, and consequently the TP/DPD ratio was significantly higher after irradiation with 20Gy than before irradiation.Conclusions: These results suggest a clinical advantage of chemoradiotherapy with capecitabine or doxyfluridine over radiotherapy alone via the elevation of the TP/DPD ratio in cervical squamous cell carcinoma. However, no advantage of combination chemotherapy with these 5-FU derivatives was demonstrated. Therefore, further evaluation with a larger number of patients or with other chemotherapeutic agents is required to confirm these observations.

Management of adult primary vulvar Langerhans cell histiocytosis: review of the literature and a case history - Corrected Proof

Samer El-Safadi, Thomas Dreyer, Frank Oehmke, Karsten Muenstedt — 2012-03-23

Abstract: Primary vulvar Langerhans cell histiocytosis (LCH) is extremely rare and there are no standard treatment options. This review of the published literature with a case report aimed to clarify the optimal treatment for patients with this condition.Medline and PubMed were searched and all cases of primary vulvar LCH reported as single case reports or small case series were reviewed. A patient with vulvar LCH treated in this department is also reported. Twenty-seven cases, including the reported case, were reviewed. First-line treatments included surgery, radiotherapy, chemotherapy, thalidomide and local treatment. The mean follow-up time was 21.1±17.7 months. Although no patient died from the disease, recurrence rates were high (62%) and the mean time to relapse was 10.9±11.8 months (range 1–36 months). Treatment with thalidomide was successful, resulting in long-lasting remission. Disease recurrence is likely after surgery and or radiotherapy, and these treatments together with chemotherapy affect the patient's wellbeing adversely. Although definitive conclusions await further work, thalidomide has minimal adverse effects, is easy to administer and should be considered as a first-line treatment or as maintenance therapy in some patients.

Results and unsolved problems following the amendment to the Italian Law on assisted reproduction brought about by the Constitutional Court - Corrected Proof

Andrea Molinelli, Alessandro Bonsignore, Valeria Darretta, Paola Anserini — 2012-03-22

Abstract: Since the approval of Law N° 40/2004, Italian specialists have been applying assisted reproductive techniques in compliance with a number of restrictions. Several attempts were made to find a solution to the practical and ethical issues brought about by this restrictive legislation. Finally, in May 2009, the Italian Constitutional Court banned most of the limitations. In the last year the authors worked together to study the impact of the Italian Constitutional Court modifications on assisted reproduction from both a gynecological and medico-legal point of view. Despite the clinically positive impact of the ruling, a lot of technical and legal unsolved issues still exist. Analyzing these problems, the authors stress the importance of a multidisciplinary approach to achieve adequate legislation in order to improve patients’ outcome and avoid “reproductive migration” from Italy to other European Countries. New regulation could also be important for practitioners by keeping the risk of legal troubles to the minimum.

Polycystic ovary syndrome and diabetes screening: a survey of gynecologists and reproductive endocrinologists - Corrected Proof

2012-03-22

Abstract: Objectives: Women with polycystic ovary syndrome (PCOS) are at high risk of developing type 2 diabetes mellitus. The purpose of this study was to assess self-reported methods used by specialists in obstetrics and gynecology (OB/GYN) and in reproductive endocrinology and infertility (REI) to screen for type 2 diabetes in women with PCOS.Study design: We analyzed responses to a web-based survey of from 123 OB/GYN and 223 REI physician members of the American Society for Reproductive Medicine.Results: Initial diabetes screening of all women with PCOS was performed by fewer OB/GYNs (57%) than REIs (71%). Approximately 1/3 of both groups reported initial screening only for those with additional risk factors, and 3% reported no screening. Re-screening for diabetes was reportedly performed by similar numbers of OB/GYNs (49%) and REIs (53%). Re-screening was reportedly not performed by the remaining 51% of OB/GYNs and 47% of REIs. For initial screening, the 2h glucose tolerance test (GTT) was reportedly used by fewer OB/GYNs than REIs (59% vs 72%), fasting plasma glucose (FPG) by more OB/GYNs (22% vs 8%), and hemoglobin A1c (HbA1c) by a similar number (19% vs 20%). For re-screening, GTT was reportedly used by a similar proportion of OB/GYNs and REIs (27% vs 32%), FPG was used more by OB/GYNs (43% vs 23%), and HbA1c was used less (30% vs 45%).Conclusions: Not all OB/GYN and REI respondents followed diabetes screening guidelines for women with PCOS. Screening rates for women with PCOS might be increased by continued educational efforts concerning their high risk for diabetes, and by the recent recommendation to use HbA1c for diabetes screening in high-risk populations.

Possible factors for altered energy balance across the menstrual cycle: a closer look at the severity of PMS, reward driven behaviors and leptin variations - Corrected Proof

Jessica McNeil, Éric Doucet — 2012-03-22

Abstract: This paper reviews the literature on the variations in energy intake (EI), energy expenditure (EE) and the factors which may affect the fluctuations in EI across the menstrual cycle. While no significant changes in body weight and body fat percentage have been noted across the cycle, increases in EI and EE have been well documented during the luteal phase in lean women. The occurrence and severity of the premenstrual syndrome (PMS) and food reinforcement are suggested to affect EI. It is not known, however, whether food reinforcement may affect EI across the menstrual cycle. These factors may also affect overweight/obese women differently than normal-weight women at times during which women may be more prone to episodes of overeating during the menstrual cycle. Certain studies have also noted fluctuations in leptin levels across the menstrual cycle, while others have not. It has also been suggested that variations in leptin levels may affect the rewarding value of food in order to maintain proper body weight and adiposity level. We emphasize that future studies should evaluate the variations in energy balance across the cycle in overweight/obese women, as well as the strength of the relationships between food reinforcement and the severity of PMS with energy and macronutrient intakes.

Progressive visual loss in a pregnant woman with idiopathic intracranial hypertension - Corrected Proof

2012-03-22

We recently treated a 35-year-old obese patient, gravida 2, abortus 1, who was referred to our hospital at 32+1 weeks of gestation for persistent visual loss in spite of increasing dosage of acetazolamide. Idiopathic intracranial hypertension (IIH) had been diagnosed five years previously, when she suffered from pulsatile headache and visual impairment. She remained asymptomatic with acetazolamide and weight control until she wanted to achieve motherhood. Then she stopped her treatment and became pregnant three months after a spontaneous miscarriage. Due to worsening of symptoms and visual deterioration during pregnancy, acetazolamide (250mg/8h) was administered again from the second trimester. She put on 10kg during pregnancy and had gestational diabetes controlled with diet.