Endometrial biopsy during induction of ovulation with tamoxifen polycystic ovary syndrome

ABSTRACT

The dichotomy between ovulation rates and pregnancy rates for women with polycystic ovary syndrome [PCOS] treated with tamoxifen prompted the present study to determine the effect of tamoxifen on endometrial maturity. To compare endometrial histology of PCOS patients on induction of ovulation with tamoxifen with controls. Prospective case-control study. Bab El-Shareya University Hospital, Cairo, Egypt. Sixty-seven anovulatory women with PCOS on their third ovulatory cycle of tamoxifen were compared with controls [n=70] healthy but subfertile regularly ovulating women whose husbands had abnormal semen parameters. All subjects had an endometrial biopsy in the late luteal phase. Endometrial histology classified according to the classical Noyes criteria revealed out-of-phase endometrium in 11/67 [16%] of the tamoxifen group compared with 2/70 [3%] in controls [p<0.001]. The incidence of out-of-phase endometrium seems to increase with higher pre-induction LH levels. Tamoxifen treatment significantly increases the prevalence of out-of-phase endometrium and this could explain, in part, the large difference between ovulation and pregnancy rates. The higher the pre-induction LH levels, the more is the possibility of the endometrium being out-of-phasestandard 12 lead ECG, laboratory investigations including CPK, IMA, CRP, lipogram, kidney and liver functions were done. Twenty two patients were diagnosed as non ischaemic chest pain [NICP] and 51 cases as ACS. CPK and troponin levels were normal in all groups at presentations but 6 hours later CPK levels were significantly higher in ACS patients if compared with NICP or control groups [p<0.000]. on the other hand, IMA levels were statistically significantly high in ACS group only [p<0.000] with a good negative predictive value to diagnose NICP [86.3%]. Moreover, IMA levels were statistically significantly higher in patients finally diagnosed as unstable angina [UA] than those who diagnosed as non ST elevation myocardial infarction [NSTEMI] [p<0.04] meanwhile, it is insignificantly higher than that in STEMI patients. The sensitivity of IMA to predict ACS cases [94.1%] was higher than that of ECG [78.4%] and CPK at presentation [14.7%] and after 6 hours [54.7%]. On the other hand, the specificity of IMA, ECG, CPK at presentation and 6 hours later [86.4%, 90.9%, 86.4% and 97% respectively]. IMA can be used at the emergency setting to exclude the diagnosis of ADS. Moreover, the use of IMA as a diagnostic biomarker in addition to standard markers of myocardial injury is very useful for the evaluation of patients with suspected ACSMedical personnel are without doubt exposed to many biological and chemical agents [e.g., ionizing radiation, ultraviolet light rays, ultrasound, alkylating agents, anesthetic gases and antineoplastic agents] which are efficient inducers of chromosomal aberrations. X-ray and ultrasound are used extensively in many branches of modern medicine. X-rays, together with gamma rays and UV light are all part of the electromagnetic spectrum. Their interaction with biologic material depends on the frequency of wavelength of the radiation. At the short wavelengths of X-rays, electromagnetic radiation has sufficient energy to produce ionization as a result of the removal of electrons from atoms, and are thus called ionizing radiation. Ultrasound [term used to describe mechanical vibrations at frequencies above the human limit of audibility] has experienced phenomenal growth in medical diagnosis in recent years and it is usable in many sensitive circumstances where X-rays might be damaging. The aim of the present study is to assess genomic damage produced by occupational exposure to X-rays and ultrasound equipment using FISH technique using the whole chromosome paint probes for chromosome 1 and 2. Our study revealed chromosomal aberration in 2 personnel exposed to ionizing radiation, continuously for more than 10 years, in the form of absent signaling of chromosomes 2 which denotes total loss [monosomy] of this chromosome. In conclusion, our results may not provide significant proof of the cytogenetic damage caused by occupational exposure to ionizing radiation and ultrasound, however it may prove useful for future human population studies in this field and surely concluded that the necessity of following safety rules in fields dealing with radiations