IL-6 and IGFII in normal ovulatory; anovulatory pcos and controlled ovarian hyperstimulation cycles

Cytokine interleukin-6 [IL-6] and insulin like growth factor II [IGF-II] are polyfunctional regulatory peptides. They have a wide variety of biological activities including ovulation regulation of gonadal steroid secretion by the ovaries, corpus luteum function and embryo implantation. To investigate their role in normal ovulation, polycystic ovary syndrome [PCOS] and controlled ovarian hyperstimulation [COH] this study is conducted. Department of Obstetrics and Gynecology and Clinical Pathology, Assiut University Hospital, Assiut, Egypt. Sixty women were included in this study from 3 groups of patients; 20 women in each group. First group includes women with normal ovulatory cycle and a second group includes women with anovulatory PCOS cycle and a third group of women prepared for assisted reproduction by [ICSI]. Three blood samples from each women were obtained at day 3 of the cycle day 12 or day of ovum pick up and day 22 of the cycle. Follicular Fluid [FF]collected at the day of ovum pick up from women undergoing [ICSI]. Blood and FFsamples were assayed for IL-6 and IGF-II as well as E2, FSH, LH and P, using [ELISA] technique. The mean values of IL-6 level in the early follicular phase in normal ovulatory, PCOS and COH groups were 12.93 +/- 0.77, 101.99 +/- 32.04 and 12.86 +/- 0.88 [pg/ml], respectively. There is highly significant increase in PCOS group in comparison to normal ovulatory and COH groups. IL-6 significantly increased in patients with increased number of follicles than those of low number of follicles in COH group. The mean values of IL-6 in late follicular phase were 11.4 +/- 0.88, 99.7 +/- 4.0, 27.3 +/- 8.0 in the three groups, respectively. The level is only significanlly increased in those patients with COH than the level in early follicular phase inside each group. The mean values of IL-6 in the mid luteal phase were 176.6 +/- 29.7 and 68.7 +/- 52.3 [pg/ml] in normal ovulatory and PCOS groups. There was highly significant increase in the ovulatory than the anvulatory cycle. There was a significant increase of IL-6 in FF at the time of ovum pick up over the serum samples taken at the same time. The mean values of IGF-II level in late follicular phase were 589.97 +/- 22.58, 466.4 +/.- 41.74 and 770.7 +/- 79.38 [ng/ml] in normal ovulatory, PCOS and COH group, respectively. The increase of IGF-II in cases of COH than normal ovulatory cycle shows its significant role in steroidogenesis which is important for the elevated E2 level in this group. IL-6 may be an early predictor for the ovarian responce and the development of ovarian Hyper stimulation syndrome [OHSS] with the othor hormonal and US parameters. IL-6 may be taken in consideration as a maker for corpus luteum function in conjunction with progesterone in day 22. The elevation of IL-6 in day 3 in PCOS patients than in the normal ovulatory cycle may partially explain the increased liability to OHSS in these patients. The significant reduction in IGF-II in cases of PCOS may play a role in anovulation

Endothelial dysfunction an doxidative stress in gestational diabetes [a follow-up study]

Gestational diabetes is characterized by glucose intolerance first recognized during pregnancy. Women with gestational diabetes are more prone to develop type II diabetes later in life. The increased risk of premature endothelial dysfunction with hyperglycemia might be related in part to augmented expression of cell adhesion molecules. Diabetes is also characterized by oxidative stress which in turn determines endothelial dysfunction via nitric oxide synthase linked pathway. Aim: To evaluate the effect of gestational diabetes on the adhesive molecules and status of oxidative stress. Subjects and Five hundred and eighty seven pregnant women [24-28 weeks of gestation] with no risk factors and normal renal and liver functions were tested for serum glucose by screen test and-when necessary- glucose tolerance curve. Thirty three cases [5.6%] who have gestational diabetes constituted the patients group. Twenty healthy pregnant women with negative screen test and glucose tolerance curve were taken as a control group. Both patients and controls were investigated for serum E- selectin, VCAM-1, endothelin-1, nitric oxide, lipid peroxidation and superoxide dismutase [SOD], during gestation and after delivery. During gestation, sE-selectin was higher and sVCAM-1 was lower in diabetic cases than controls but with no significant differences, while significant elevations of lipid peroxidation [p < 0.01] and SOD [p < 0.001] in patients group compared to control group. Three months after delivery, significant elevations of sE-selectin [p < 0.001], sVCAM-1 [p < 0.001], and SOD [p < 0.001] were observed in women with gestational diabetes compared to the controls. There were significant reduction in lipid peroxidation and SOD [p < 0.001] in the patients after delivery as compared to that during pregnancy, while sE-selectin, sVCAM-1 and NO were higher after delivery than during pregnancy but the difference was statistically insignificant. The controls showed significant decrease in levels of endothelin-1, sE-selectin and sVCAM-l with longitudinal follow up. The follow up study revealed that six cases [patients group A] continued with impaired glucose toerance curve [31.6%] and thirteen cases [patients group B] returned with normal glucose curve. In group A, there were significant elevation of E-selectin [p < 0.05] and significant decrease of endothelin-l [p < 0.01] as compared to group B, while NO and SOD were reduced but the difference was statistically insignificant. Sustained elevations of sE-selectin and sVCAM-1 in cases with gestational diabetes even after delivery may reflect vascular injury or risk factor for endothelial dysfunction. Furthermore the elevations of lipid peroxidation and SOD in the patients group during pregnancy may be implicated this pathogenesis of gestational diabetes and may be considered as sensitive indicators of oxidative stress in gestational diabetes

Cesarean section in mild preeclamptic patients; spinal versus epidural anesthesia

This study was carried out in Assiut University Hospital in the Department of Obstetrics and Gynecology, in the period from January 2002 to January 2003. The study was approved by our local institutional ethics committee. All patients had been informed about the nature of the study and a written or verbal consent was obtained from each one. Forty parturients with mild pre-eclampsia [systolic blood pressure 140-160mm/Hg diastolic blood pressure 90-100mm/Hg] undergoing cesarean section, with no contraindication for regional anesthesia [sepsis,bleeding tendency, severe stenotic valvular heart disease and platelet count < 100000 mm3] were enrolled in the study. General and obstetric examination as well as obstetric ultrasonography were done for all women. Patients were allocated randomly into two groups; group 1 received spinal anesthesia, bupivacain 0.5% [[8-12 mg] [2-2.5ml]] and group II received epidural anesthesia, bupivacain 0.5% [[30 -40 mg] [6 -8ml]] and lidocaine 2% [[120-160 mg] [6- 8ml]]. Hemodynamic data [systolic, diastolic, mean blood pressure and heart rate] were recorded immediately before induction of anesthesia and every 5 minutes after induction till the end of the operation. Neonatal outcome was assessed by Apgar score at I minute and 5 minutes any infra-operative complication was recorded. Amount of blood loss was subjectively assessed by the obstetrician. The quality of anesthesia was assessed in the two groups by sensory level determination and Bromage scale for motor block assessment, subjective assessment of the quality of anesthesia was done using VRS scales. Amount of crystalloid fluid and ephedrine doses were estimated. Side effects such as hypotension, bradycardia, nausea, and vomiting were recorded. The study showed that: Blood pressure decreased significantly after induction of regional block at 5, 10 and 15 minutes than the baseline value in the two groups, where it was lower in group I than group II. Heart rate decreased significantly after induction of regional block than the baseline value in both groups but was within the physiologic range. Neonatal outcome was favorable in both groups, Apgar score at 1 minute and 5 minutes >8 points. No recorded intra-operative complications and blood loss was average. As regards the quality of anesthesia The motor and sensory block were more pronounced in spinal group than epidural group, the patients were more satisfactory and comfortable in spinal than epidural group. The amounts of crystalloid fluid and ephedrine used for prevention and treatment of hypotension were comparable with no significant difference between both groups. Side effects: There were insignificant difference between the two groups as regards nausea, vomiting, bradycardia hypotension and shivering. The regional anesthesia [Spinal-epidural] is a sound choice in mild pre-eclamptic parturient provided that all risk factors [including thrombocytopenia and platelet function defect] are assessed and the patient is stable. The amount of blood loss is within normal and the neonatal outcome is satisfactory. Spinal anesthesia is superior to epidural anesthesia, because both techniques have similar haemodynamic changes and neonatal outcome. However, the spinal anesthesia has many advantages over epidural anesthesia like easy technique, less time consuming, less cost, intense sensory and motor block and patients with spinal anesthesia are more satisfactory than with epidural anesthesia, the surgeon also feels more satisfied. This study was carried out in mild preeclamptic parturient and further studies are needed to evaluate maternal and neonatal safety of these techniques in severe pre-eclampsia

Acceptability for the use of postpartum intrauterine contraceptive devices: Assiut experience

To evaluate the acceptance of postpartum intrauterine contraceptive devices [PPIUCD] among the inhabitants of Assiut governorate, Egypt and to study the factors that influence this acceptance. Subjects and Contraceptive counseling was given to 3,541 clients: 1,880 and 1,661 during the antenatal visits and postpartum hospitalization, respectively. Acceptors during antenatal counseling were to receive IUCDs via postplacental insertion in the case of vaginal delivery or transcesarean insertion in case of abdominal delivery. The clients who refused PPIUCD and chose interval IUCD insertion were referred to the Family Planning Clinic after the end of puerperium. Among postpartum counselees, PPIUCD acceptors received predischarge insertion within 48 h of delivery and the interval IUCD were referred to have IUCD inserted after the end of puerperium. The acceptance rate of both PPIUCD and interval IUCD and the percentage of actual insertions were recorded. The causes of both acceptance and refusal were also recorded. Of the 3,541 clients, 1,024 [28.9%] accepted the use of IUCD after delivery. Acceptance was approximately the same during antenal and postpartum counseling: 26.4 and 31.8%, respectively. Verbal acceptance was higher among women with formal education than among illiterate women. Planning another pregnancy in the near future, preference for another contraceptive method, namely lactational infertility, and complications from previous use of IUCD were the most common reasons for refusing the use of IUCD. Of the 1,024 verbal acceptors, only 243 [23.7%] had the actual insertion of IUCD. Both the acceptance and actual insertion of IUCD were low probably because the use of IUCD is a new concept in the community. For these women, the only opportunity to receive information about contraceptives is during childbirth when they are in contact with medical personnel. Hence, it is suggested that family planning should be integrated with maternal and child-care services in order to effectively promote the use of contraceptive devices in these women who otherwise would not seek the use of such a device

Value of transrectal ultrasonography in the assessment of azoospermic patients before ICSI

The purpose of this article is to evaluate the role of ultrasonography of male reproductive system, especially scrotal and transrectal ultrasonography in the management of infertile males before ICSI as a predictive value for sperm recovery in testicular sperm extraction [TESE]. In this study selected group of 140 infertile men with azoospermia were examined with scrotal and transrectal US. According to clinical and transrectal examination, these patients were subdivided into two groups. Group I of 64 patients had evidence of major obstructive abnormalities of male genital tract system and group II of 76 patients had no or minor non obstructive transrectal US abnormalities. All the 140 patients in the last two semen analysis have azoospermia which persists in spite of medical or surgical treatment. In group I, five patients had congenital bilateral absence of the vas deferens, two have congenital unilateral absence of the vas deferens and congenital obstructive pathology of the contralateral duct system. Proximal or distal duct system obstruction was diagnosed in 57 cases. These patients have a normal FSH level and small volume of ejaculate, and significantly higher testicular volume. In 61 patients of them [95.3%] testicular sperm were found in testicular biopsy. The other 76 patients in Group II were subdivided into two categories according to the presence or absence of minor non-obstructive transrectal abnormalities. In the 30 patients who had additional abnormalities thought to be directly related to semen deficiency 17 cases [56.7%] showed sperms in testicular biopsy. These patients have FSH at the upper level of normal with testicular volume at lower level of normal and with low ejaculate volume. In the remaining 46 patients with high level FSH, low testicular volume in US with normal ejaculatory volume and within normal transrectal US, only 19 cases [41.3%] showed sperms in testicular biopsy

Schistosomiasis as a possible cause of female infertility

This study was conducted on 1625 infertile women selected for laparoscopy over a two-year period. All the patients were subjected to urinalysis, hysterosalpingography, endometrial biopsy in addition to semen analysis of their husbands. Laparoscopic guided biopsy of suspicious lesions of genital organs was taken. Histopathological evidence of schistosomiasis was proved in 27 cases. Twenty cases of them had only tubal affection, ten cases had hydrosalpinx and ten had granulomata on the outer surface of the tube. Three had peritubal small cysts formation. Two had tubo-ovarian masses and two cases showed peritoneal nodules. The histopathology of all lesions showed the characteristic of bilharzial ova

Modified vecchietti operation for creation of a neovagina

In the modified technique, a simple apparatus utilizing the principles of the original Vecchietti operation was used but without opening the bladder peritoneum. First opening the skin through a small Pfannenstiel incision, followed by the rectus sheath, then dissected the retropubic space without opening the peritoneum. After threading an unabsorbable thread in the olive, the Stamy needle was used to pass the threads on each side of the bladder neck and the upper ends of the threads were passed lateral to the two recti muscles and fixed on a traction apparatus on the abdomen. A total of 23 patients were operated upon. Before the operation, the mean length of the vaginal pouch was 1.7 +/- 0.45 cm and the mean length became 8.1 +/- 1.6 cm at the end of the traction after the operation. Except transient stress incontinence in one patient, no complications were recorded. The advantages of the operation were that the normal anatomy and innervation were maintained. It was an extraperitoneal approach with low incidence of complications and there was no perineal scar allowing sexual intercourse within two weeks after discharge from the hospital