Serum human epididymis protein 4 can be a useful tumor marker in the differential diagnosis of adnexal masses during pregnancy: a pilot study.

PURPOSE: The purpose of this study was to evaluate serum concentrations of human epididymis protein 4 (HE4) and cancer antigen 125 (CA 125) in healthy women and their pregnant counterparts to determine the influence of pregnancy on these biomarkers. MATERIALS AND METHODS: Serum concentrations of CA 125 and HE4 were measured in 27 healthy non-pregnant women and 26 healthy pregnant women in the first and second trimesters. RESULTS: Higher concentration of CA 125 was found in pregnants than in non-pregnant women (p = 0.002). There was no difference in CA 125 concentrations between first and second trimesters (p = 0.13). Serum HE4 concentration was not different in pregnant group compared to non-pregnant women (p = 0.510). Likewise, no difference was found in HE4 levels between the trimesters (p = 0.485). There was a positive correlation between increasing parity and CA 125 (p = 0.023), but not HE4 (p = 1.0). CONCLUSION: HE4 serum biomarker is unaffected by pregnancy status and may be useful for evaluation of doubtful pelvic masses in pregnancy. Contrarily, increased serum levels of CA 125 could yield increased number of false-positive results.

The effect of ovariectomy on the skin flap viability and myeloperoxidase levels.

OBJECTIVES: Estrogen could affect the rate and quality of wound healing in skin. We aimed to investigate the effects of ovariectomy on skin flap viability and myeloperoxidase (MPO) levels in a rat model. BACKGROUND: Estrogens have many important beneficial and protective roles in skin that they improve collagen content and quality, maintain skin thickness and enhance vascularization. It has been shown that estrogen supplementation accelerates cutaneous wound healing in elderly patients. METHODS: Forty-eight cycling female Wistar albino rats were randomly divided into three groups (n = 16); ovariectomy (Group 1), sham (Group 2), and control (Group 3). Rats were subjected to bilateral ovariectomy in the Group 1, and only laparotomy in the Group 2. Twenty-one days later in the Group 1 and 2, a dorsal caudally based skin flap elevation was done. In the Group 3, the rats had a dorsal skin flap without any surgical intervention. Ten days later, the flaps were harvested for histopathologic examination and biochemical analyses. RESULTS: The rats in the Group 1 had significantly larger necrotic area and lower flap viability than in the Group 2 and 3 (p<0.05). Histopathologic examination showed that necrotic flap regions contained muscle necrosis with an abundant neutrophil infiltration, and severe edema in the Group 1. The MPO activity in the distal of skin flaps was significantly higher in the Group 1 compared to the Group 2 and 3 (p<0.05). CONCLUSION: This study shows that ovariectomy has deleterious effects on skin flap viability in a rat model (Tab. 1, Fig. 6, Ref. 44).

Does ovarian endometrioma affect the number of oocytes retrieved for in vitro fertilization?

OBJECTIVE: To investigate the effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization (IVF). BACKGROUND: The presence of endometrioma may be the most important predictor of a poor reproductive outcome. Literature data suggest that ovarian endometriomas might affect the response to ovarian stimulation and oocyte retrieval. METHODS: The present retrospective study evaluates 2,023 women who applied to our center with an infertility complaint. Twenty-nine women with endometriomas (group 1) who were treated with IVF were included in the study. They were compared with 51 women with unexplained infertility (group 2) regarding the number of retrieved oocytes after egg retrieval and number of metaphase II oocytes. The diagnosis of endometrioma was made via ultrasound examination with the identification of low-density cystic masses in the ovaries. The patients underwent a controlled ovarian hyperstimulation (COH) with either the long agonist mini-dose protocol or the multi-dose antagonist protocol. RESULTS: The incidence of endometrioma in infertile women was found to be 1.4 %. The women's ages ranged between 24 and 45 years, and the duration of their infertility ranged between 12 and 216 months. The endometrioma was bilateral in 24 % of the cases. The mean endometrioma diameter was 26.2±7.3 mm for the right ovary and 23.2±6.1 mm for the left ovary. The average number of retrieved oocytes after egg retrieval in groups 1 and 2 was 12.4±8.3 and 12.2±8.6, respectively. The average number of metaphase II oocytes in groups 1 and 2 was 8.6±6.1 and 9.4±7.3, respectively. The number of retrieved oocytes after egg retrieval and the number of metaphase II oocytes in both endometrioma group and unexplained infertile group were similar (p >0.05). CONCLUSION: Endometrioma did not reduce the number of retrieved oocytes in a COH cycle for IVF treatment. However it should be noted that the ovarian response is affected by the size of endometriomas, bilaterality, previous surgeries, recurrence, and the patient's age (Tab. 1, Ref. 31).