Potential applications of human embryonic stem cells.

Advances in reproductive technologies provided opportunity for scientists to be able to grow human embryos in vitro for more than two decades. Skills and knowledge derived from in vitro fertilization and in vitro culture of mammalian embryos opened the chance for scientists to develop the strategies to derive embryonic stem cell lines from mammalian and human embryos. This achievement has initiated a new era in the fields of biotechnology, pharmacology, basic scientific research, and cell-based medicine. To date, scientists have made some progress in optimizing regimens in deriving ES cell lines from human embryos but much more research and development are still required especially in the aspect of directing stem cells into the specific cells of potential clinical use. Collaboration among clinicians and scientists from diverse fields, together with the public awareness of how useful this technology could be to modern medicine, will result in the accumulation of knowledge in this field and, in the near future, a progress in cell-based therapy.

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

Endometrial abnormalities in postmenopausal breast cancer patients.

OBJECTIVE: To determine the prevalence of endometrial thickening and pelvic pathologies in postmenopausal breast cancer patients. MATERIAL AND METHOD: A total of 66 postmenopausal breast cancer patients receiving treatment at Srinagarind Hospital from 1 July 1999 to 31 August 2000 were included in the study. Patients who had been treated with hormones such as tamoxifen or progestins were not eligible for this study. Thorough history taking and physical examination as well as transvaginal ultrasonography were conducted in all study patients. Fractional curettage was carried out and the specimens obtained were sent for pathological examination in all patients whose endometrial thickness was found to be greater than 5 mm on the ultrasound scan. RESULTS: Among the 66 patients included in this study, the mean age was 54.97 years. The majority of patients (75.76%) had stage II disease. The mean +/- SD of endometrial thickness found in this study was 3.55 +/- 1.72 mm. The prevalence of thickened endometrium (defined as ET > 5 mm from TVS) was 10.60% (7 from 66 cases). Other pelvic pathologies detected by ultrasonography were myoma uteri (4.55%) and ovarian mass (1.52%). Among the seven patients whose endometrial thickness was found to be greater than 5 mm, results of curettage specimens revealed inadequate tissue obtained (42.85%), atrophic endometrium (28.57%), active endometrial gland (14.29%), and scanty stromal cell (14.29%). CONCLUSION: The prevalence of thickened endometrium in postmenopausal breast cancer patients found in this study was interestingly high. The pathological results of such cases, however, turned out to be negative for neoplastic changes in all cases. Further study, thus, is needed before precise recommendation could be made regarding the value of TVS screening in breast cancer patients not taking tamoxifen.

Increased risk of endometrial abnormalities in breast cancer patients taking tamoxifen: the need for gynaecologic surveillance.

OBJECTIVE: To evaluate the risk of abnormally thickened endometrium associated with tamoxifen treatment in postmenopausal breast cancer patients. METHODS: Two groups of asymptomatic postmenopausal breast cancer patients were recruited in the study. The first consisted of 70 patients taking 20mg/day of tamoxifen for at least 6 months. The second group included 140 patients without tamoxifen treatment. Endometrial evaluation using transvaginal ultrasonography (TVS) was conducted for all patients. Fractional curettage was carried out for patients whose endometrial thickness was greater than 5 mm on TVS. RESULTS: The prevalence of abnormally thickened endometrium (greater than 5 mm on TVS) was significantly higher in patients receiving tamoxifen (58.57% VS 10.71 %, P = 0.0001). Patients undergoing tamoxifen treatment had a 5.61 relative risk of developing abnormally thickened endometrium (95% CI= 2.65 -11.86). CONCLUSION: Tamoxifen significantly increases the risk of developing abnormally thickened endometrium in postmenopausal breast cancer patients. There is, thus, a true need for gynaecologic surveillance in such patients to early detect neoplastic change of endometrium that may arise as a result of tamoxifen use.

Surveillance for endometrial cancer in postmenopausal breast cancer patients taking tamoxifen.

OBJECTIVES: To determine the prevalence of endometrial thickening and endometrial pathologies in postmenopausal breast cancer patients taking tamoxifen. MATERIALS AND METHODS: A total of 37 postmenopausal breast cancer patients receiving 20 microg/day of tamoxifen treatment for at least 6 months at Srinagarind hospital were included in the study. Thorough history taking and physical examination as well as transvaginal ultrasonography were conducted for all patients. Fractional curettage was carried out in those whose endometrial thickness was found to be greater than 5 mm. RESULTS: Among 37 patients included in this study, the mean age was 56.35 years. The mean body weight and mean body mass index was 60.88 kg and 26.03 kg/m(2), respectively. The majority of patients (75.68%) had stage II disease. The mean + SD of endometrial thickness found in this study was 7.53 + 5.16 mm. The prevalence of thickened endometrium (defined as ET > 5mm from TVS) was 59.46%. Among the 19 patients for whom fractional curettage was conducted, the majority (73.69%) exhibited inadequate endometrium for evaluation. Atrophic endometrium and other unremarkable changes were found in 21.05% of patients and it is important to note that endometrial adenocarcinoma was detected in 1 case (5.26%). CONCLUSIONS: The prevalence of thickened endometrium in postmenopausal breast cancer patients taking tamoxifen found in this study was extraordinarily high. These is, however, a discrepancy between the value and that for endometrial abnormalities detected histologically.

Pseudo-Meigs' syndrome secondary to subserous myoma uteri: a case report.

A 45 year-old Thai woman, gravida 5, para 5 presented with a huge pelvic mass as well as ascites and right pleural effusion. Right thoracocentesis was performed pre-operatively and malignant cells could not be detected on the cytological examination of the pleural fluid. Surgical exploration revealed a large pedunculated subserous leiomyoma of the uterus without malignant transformation. Total abdominal hysterectomy with bilateral salpingooophorectomy and appendectomy were performed. Both ascites and pleural effusion resolved post-operatively and did not recur during the 12-month follow-up. This case demonstrated the extremely rare case of pseudo-Meigs' syndrome caused by a subserous uterine leiomyoma.