Comparison of the prognostic values of inhibin and CA-125 as tumour markers for ovarian masses diagnosed by ultrasonography

To evaluate the performance of screening for ovarian malignancy by serum assay of inhibin and cancer antigen [CA-125] in patients with ultrasonographically diagnosed ovarian masses. Their predictive efficacy as tumour markers will also be assessed. Two-year observational, cross-section study of screening performance. Al-Azhar University Hospitals in Damietta and Cairo. 60-women with ovarian masses larger than 10cm were enrolled in this study. All patients were subjected to a complete medical history, clinical and ultrasonographic examinations. Laboratory assay of serum inhibin and CA-125 were performed before surgical procedure and repeated at 3-week and 6-month postoperative visits. All ovarian specimens were examined histopathologically. Mean concentrations of serum inhibin and CA-125. The mean concentrations of serum inhibin and CA-125 declined significantly in patients with benign ovarian masses at 3-week and 6-month follow-up visits in comparison with baseline concentrations [8.01 +/- 3.91 and 7.07 +/- 3.22 vs 14.30 +/- 5.42pg/mL; 24.60 +/- 5.19 and 24.30 +/- 10.72 vs 32.10 +/- 10.41U/mL, respectively]. [p+<0.05]. It was evident that the mean concentrations of serum inhibin and CA-125 were significantly higher in patients with malignant ovarian masses than in those with benign ovarian masses [p*<0.001]. In malignant ovarian mass group, there was a significant reduction of serum inhibin and CA-125 at 3-week and 6-month follow up visits in comparison with the baseline concentrations [21.60 +/- 2.35 and 21.60 +/- 3.07 vs 58.10 +/- 20.62pg/mL; 34.31 +/- 11.56 and 33.32 +/- 12.50 vs 69.81 +/- 27.72U/mL, respectively] [p+<0.05] The serum levels of inhibin and CA-125 were significantly higher in patients with endometrioid cysts than that in patients with other benign ovarian tumours [p<0.05]. In addition, the mean concentrations of serum inhibin and CA-125 were significantly higher in patients with dysgerminoma [82.70 +/- 21.20pg/mL and 63.52 +/- 15.90U/mL, respectively] compared with other pathological types of malignant ovarian tumours [p<0.05]. Considering the predictive efficacy of the studied tumour markers, elevated serum levels of inhibin and CA-125 could predict ovarian malignancy with a sensitivity of [82% vs 85%], specificity of [85% vs 78%], positive predictive value of [87% vs 82%], and negative predictive value of [79% vs 81%], respectively [p>0.05]. Screening modality of plasma inhibin assay has been proven to be efficacious as a tumour marker for ovarian malignancy. It has a predictive efficacy comparable to that of CA-125. Their use together could potentially improve sensitivity and specificity in screening for ovarian cancer

Prediction of ovarian response by comparing basal markers of ovarian reserve in invitro fertilization

Sixty women undergoing their first invitro fertilization cycle [IVF] were included in this prospective study which was performed at Al-Azhar University Hospital, Dammieta from April 2003 to May 2005 to identify and compare predictors of poor ovarian response in IVF. The number of antral follicles and total ovarian volume were measured by transvaginal ultrasound [TVS] on cycle day 3 followed by the measurement of basal levels of follicle stimulating hormone [FSH], estradiol [E2] and inhibin B. The antral follicle count was the best single predictor for poor ovarian response: Area under the receiver characteristic curve = 0.88. Addition of basal FSH and inhibin B levels to a logistic model with antral follicle count significantly improved the prediction of poor response. Addition of E2 and total ovarian volume didn't improve the prediction. On conclusion the antral follicle count provides better prognostic information on the occurrence of poor response during hormonal stimulation for IVF than does the currently used endocrine markers. However, addition of endocrine markers mainly FSH and inhibin provide more prediction

Comparative study between effect of aromatase inhibitor and clomiphene citrate in gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility

To compare the effects of aromatase inhibitor, letrozole and clomiphene citrate [CC] in gonadotrophin dose required for controlled ovarian stimulation [COS] in patients with unexplained infertility undergoing intra uterine insemination [IUI]. Non randomized prospective study. Al-Azhar University Hospital, Dammieta. Ninety patients with unexplained infertility undergoing COS and IUI. Thirty two women received letrozole in a dose of 2.5mg/day from day 3 to day 7 of the menstrual cycle + FSH, 18 women received CC in a dose of 100mg/day from day 3 to day 7 of the menstrual cycle + FSH and 40 women received FSH only as a control group. All patients were given highly purified FSH [75-150IU] starting of day 3 to day 7 until the day of hCG administration. Total FSH dose/cycle, number of mature ovarian follicles, estradiol [E2], lutenizing hormone [LH] levels, endometrial thickness, cervical mucus score at the day of hCG and pregnancy rate. The FSH dose was significantly lower in letrozole + FSH group and CC + FSH group when compared with FSH only group without a difference in number of follicles >/= l8mm. E2 levels were significantly lower in the letrozole + FSH group compared with the other two groups. Cervical mucus score, endometrial thickness and pregnancy rate were significantly lower in CC + FSH group when compared with the other two groups. Similar to CC, aromatase inhibition with letrozole reduces FSH dose required for COS without the undesirable anti-estrogenic effects sometimes seen with CC

First trimester ultrasonographic detection of fetal aneuploidies and fetal structural abnormalities in an unselected population

To determine the value of early pregnancy ultrasonography in detecting fetal structural and chromosomal abnormalities in an unselected obstetric population. Prospective, observational, cross-sectional, screening study. Al-Azhar University Hospitals in Damietta and Cairo. 1500 sequential unselected women [mean maternal age 28.3 years, range 18-42; mean gestational age 12 +4 weeks, range 11-14], carrying 1468 live fetuses participated in this study. All women initially underwent transabdominal ultrasonograpy and when the anatomical survey was considered to be incomplete, transvaginal ultrasonography was also performed [20.1%]. Nuchal translucency was measured and karyotyping was performed as appropriate. Detection rate of fetal anomalies and measurements of nuchal translucency thickness. Pregnancy outcome was obtained through karyotyping, outcome questionnaires and examination of the newborn infants. The incidence of anomalous fetuses was 1.4% [21/1468] including 9 chromosomal abnormalities. The detection rate for structural abnormalities was 62.5% [10/16] and the specificity was 99.9% in early pregnancy. When the first and second trimester scans were combined, the detection for structural abnormalities was 81% [13/16]. Hundred percent [9/9] of chromosomal abnormalities were diagnosed at 11-14 weeks, either because of a nuchal translucency greater than or equal to the 99 th centile for gestational age [66.6%; 6/9] or due to the presence of structural abnormalities [44%; 3/9]. Hundred percent [6/6] of cases of trisomy 21 were also diagnosed either because of having a nuchal translucency >/= 99 th centile [67%; 4/6] or due to the presence of a structural abnormality [33%; 2/6]. It was found that a cut-off point >/= 3 for fetal nuchal translucency could predict trisomies 21 and 18 with a sensitivity 67 and 50%, specificity 96.6 and 96.6%, positive predictive value 7.5 and 2% and negative predictive value 99.8 and 99.9%, respectively. A significant proportion of fetal structural and chromosomal abnormalities can be detected by ultrasonographic screening at 11-14 weeks, but the second trimester scan should not be abandoned. The sensitivity of detection can be improved by combining measurement of nuchal translucency with detailed examination of fetal anatomy

Manometric and ultrasonographic assessment of anal sphincter function following forceps or vacuum assisted vaginal delivery

To compare differences in anal sphincter function following vacuum or forceps assisted vaginal delivery. Prospective, r and omized controlled trial. Al-Azhar University Hospitals in Damietta and Cairo.One hundred and thirty primiparous women were recruited antenatally and if an instrumental delivery was indicated, were r and omized to either a vacuum or low-cavity, non-rotational forceps assisted delivery. Follow-up consisted of a symptom questionnaire, anal manometry, and endoanal ultrasonography. Faecal continence scores, anal manometry and endoanal ultrasonography. Sixty-one women delivered with forceps assistance [42 for failure to progress in the second stage] and 69 with vacuum assistance [50 for failure to progress]; 16/69 vacuum deliveries proceeded to a forceps assisted delivery [23%]. There were no statistical differences in the antecedent antenatal factors between the two groups. A third degree perineal tear followed 7 [11%] forceps and 3 [4%] vacuum deliveries. Based on intention-to-treat analysis, 32 [52%] women complained of altered faecal continence after forceps delivery compared with 21 [30%] following vacuum delivery three months postpartum. Endoanal ultrasonography was reported as abnormal following 34 [56%] forceps deliveries and 34 [49%] vacuum deliveries. After exclusion of 'failed vacuum', median anal canal resting pressure was significantly lower following forceps delivery compared with vacuum delivery alone [p<0.001]. There were no significant differences in degree of ultrasound abnormality between the two groups. Symptoms of altered faecal continence are significantly more common following forceps assisted vaginal delivery. Based on continence outcome, when circumstances allow, vacuum should be the instrument of first choice in assisted delivery