ABSTRACT
Background: Polycystic ovary syndrome [PCOS] is a common complex genetic condition of women in the reproductive age. PCOS is a heterogeneous syndrome characterized by clinical/biochemical androgen excess, ovulatory dysfunction and polycystic ovaries. Metformin therapy has been proved to improve fertility in patients with PCOS, inducing not only high ovulation and pregnancy rates, but also reducing the incidence of miscarriages
Aim of the Work: This study was aimed to evaluate the effects of metformin therapy on hormonal profile and endometrial tissue, including pattern of immunohistochemical expression of androgen receptors [AR], in patients with PCOS
Patients and Methods: 100 patients with PCOS were included in this study. Each investigated case was submitted to detailed medical history, clinical examination that included body hair distribution, body weight, height and body mass index [BMI], transvaginal ultrasound, laboratory investigations [included fasting insulin, free testosterone, LH and FSH levels]. Endometrial pipelle samples were taken for histopathological evaluation and assessment of androgen receptor expression. These investigations were done before and after three months of metformin treatment
Results: A significant decrease of BMI of the investigated cases after metformin therapy was observed [P value <0.003]. There was a significant decrease of LH level after metformin therapy from 9.17 +/- 2.84 Miu/ml to 6.18 +/- 3.6 Miu/ml and of fasting insulin level from 14.3 +/- 4.3 to 8.2 +/- 5.9. Insignificant increase of FSH level from 3.87 +/- 1.8 to 4.85 +/- 2.6 and also insignificant decrease of free testosterone level from 1.58 +/- o.83 to 1.38 +/- 1.4 were also observed. Histopathological results of the endometrial specimens before metformin therapy revealed histologic features of early proliferative endometrium in 64 cases, 20 cases with a late proliferative endometrium and examination of the remaining 16 cases revealed features of simple endometrial hyperplasia. Among the 64 cases diagnosed as early proliferative endometrium before the therapy, 60 cases showed features of a late proliferative endometrium after treatment and the remaining 4 cases showed no histomorphologic changes. Among the 20 cases diagnosed as a late proliferative endometrium before therapy, 6 cases showed features of early secretory phase after therapy, 6 cases showed features of mid-secretory endometrium while the remaining 8 cases showed a late secretory endometrium that indicate successful ovulation after therapy. Regression of hyperplasia after therapy was noted in 6 of the 16 cases diagnosed as simple endometrial hyperplasia. Immunohistochemical [IHC] results revealed marked increase in endometrial AR expression in patients with PCOS compared to the normal fertile controls [p<0.004]. Also, a significant decrease of AR expression in endometrial epithelial and stromal cells after metformin administration in patients with PCOS was noted [p<0.003]
Conclusion: Metformin therapy restores normal menstrual cyclicity in patients with PCOS, induces ovulation and showing significant decrease in endometrial AR expression
ABSTRACT
Background: Triangular fibrocartilage complex [TFCC] injury is major cause of ulnar side wrist pain. It can lead to distal radio ulnar joint instability
Aim of the work: was to examine the efficacy of arthroscopic management of the TFCC injuries, and assess the functional outcome of this procedure
Patients and Methods: Twenty patients with torn TFCC underwent arthroscopic management. Five patients had central TFCC tears to which arthroscopic debridement was done. Five patients had superficial peripheral TFCC tears to which arthroscopic reattachment to the capsule was done. Ten patients had deep foveal TFCC tears with DRUJ instability to which arthroscopic assisted foveal reattachment by suture anchor was done. All patients were assessed before and after surgery [at follow-up] by Visual Analogue Scale [VAS] for pain, the Disability of the Arm, Shoulder and Hand [DASH] score, the Modified Mayo Wrist Score [MMWS], and the incidence of complications
Results: Twenty patients were available for follow-up at a mean of 12.9 months. VAS improved from a mean of 6 to a mean of 1.3 [p<0.001]. The DASH score improved from a mean of 28.2 to a mean of 5.8 [P < 0.001]. MMWS improved from a mean of 66.3 to a mean of 88.5 [p<0.001]
Conclusion: Arthroscopic management of TFCC tears has shown to reach good results according with different TFCC lesions and improvement in pain and function. However, the current study is limited by absence of conservative or open control group for comparison and the relatively short follow-up period
ABSTRACT
Objective: To investigate the expression and function of interleukin-18 [IL-18] protein in synovial tissue [ST] of patients with rheumatoid arthritis [RA]
Methodology: IL-18 and IL-18 receptors [IL-18R] mRNA expression was detected by reverse transcription-polymerase chain reaction [RT-PCR]. Expression of IL-18 at protein level was analyzed by western plotting technique. Cytokines; [IL-18 and interferon-gamma [IFN-gamma]] in culture supernatants from ST cell organ and synovial cultures were measured by ELISA. Samples: The ST samples were taken from 29 RA patients and 23 osteoarthritis patients [OA] were included as controls
Results: Using RT-PCR, for RAST and OAST, mRNA expression of IL-18 was detected in 26 out of 29 [89.7%] RA patients and in 11 out of 23 [47.8%] OA controls. However, mRNA expression of IL-18 R alpha and beta chains were detected in 26 and 24 out of 29 [89. 7% and 82.8%] RA patients, respectively. OAST did not express ,nRNA of alpha and beta chains of IL- 18 R. In vitro study of IL-18 production by ST showed significantly higher levels in RA compared to that of OA patients [p<0.005]. Western blotting revealed that RAST expressed IL-18 more abundantly than OAST [p<0.02]. Only IL-12, but not IL-18, stimulates IFN -gamma production by RAST cells [M +/- SD=230 +/- 17 pg/ml]. However, when IL-12 was combined with IL-18, they could significantly stimulate IFN -gamma production by RAST cells [M +/- SD= 612-B5 pg/ml]. OAST cells did not respond to neither to IL- 12 alone nor when combined to IL-18
Conclusion: IL-18 is expressed in RA synovia and contributes to the production of IFN -gamma by the infiltrating T-cells. These cytokines could play a role in the synovial inflammation in RA patients