Falsely elevated human epididymis protein 4 results and Risk of Ovarian Malignancy Algorithm in polymorbid women after solid organ transplantation: A pilot and case-control study.

BACKGROUND: Cancer prevention is essential after transplantation (Tx). The use of HE4 and Risk of Ovarian Malignancy Algorithm (ROMA) is recommended as a tool for selective ovarian cancer screening; however, creatinine is a known confounder. This study assessed the reliability of HE4, CA125, and ROMA after Tx. METHODS: We matched a total of 202 women without gynecological malignancies and 236 men by age and serum creatinine. Each pair consisted of a patient after Tx (kidney, liver, heart, and pancreas) and a diseased but non-Tx consecutive patient. Serum HE4, CA125 (Roche Cobas 6000), and creatinine (enzymatic, Abbott Architect) were measured in all patients. RESULTS: Creatinine correlated with HE4 (women: r = .864, P < .0001; men: r = .848, P < .0001). Age correlated slightly with HE4 in women (r = .250, P < .005) and men (r = .240, P < .0005). HE4 in women after Tx (median of 84.8 pmol/L) was significantly higher than non-Tx women (53.7 pmol/L, P < .0001) in the reference range of serum creatinine. Neither HE4 nor CA125 correlated with tacrolimus concentration, but anemia, hyperparathyroidism, kidney, liver, and lung diseases were possible confounders for HE4 after transplantation (P < .05). CONCLUSION: Human epididymis protein 4 (HE4) was significantly increased in women after solid organ transplantation compared to levels without transplants matched by age and serum creatinine. HE4 results may be misleading in these patients.

Comparative outcomes of hysteroscopic examinations performed after uterine artery embolization or laparoscopic uterine artery occlusion to treat leiomyomas.

Hysteroscopic examination of the uterine cavity revealed that patients previously treated for intramural myoma(s) by uterine artery embolization had a significantly higher incidence of abnormal findings compared with patients treated by laparoscopic occlusion of uterine arteries (59.5% vs. 2.7%). In particular, there was a higher incidence of necrosis in the uterine cavity of patients subjected to uterine artery embolization (43.2%) compared with patients after surgical uterine artery occlusion (2.7%).

Successful pregnancy after thermal balloon endometrial ablation followed by in vitro fertilization and embryo transfer.

OBJECTIVE: To describe a case of successful pregnancy after IVF-ET in a patient with previous thermal ablation of the endometrium by uterine balloon therapy (UBT). DESIGN: Case report. SETTING: University hospital. PATIENT(S): Polymorbid patient who received UBT and became pregnant after IVF-ET. INTERVENTION(S): UBT, IVF-ET, and caesarean section. RESULT(S): After UBT, the patient underwent IVF-ET and gave birth to a healthy newborn at 36 weeks' gestation with a birth weight 2900 g and placenta accreta. CONCLUSION(S): Patients who wish to become pregnant after endometrial ablation should undergo preconception consultation and hysteroscopic examination.

Minimally invasive and hysteroscopic diagnosis and treatment of patients after organ transplantation.

AIM: To assess the safety of minimally invasive and hysteroscopic diagnosis and treatment of abnormal uterine bleeding and intrauterine abnormalities in patients after organ transplantation. METHODS: After kidney, pancreas, or liver transplantation, patients who presented with menorrhagia, submucosal myoma or thickened endometrium on ultrasound were diagnosed and treated using a hysteroscopic system Versascope, Bipolar Resectoscopic System and intrauterine system ThermaChoice. RESULTS: Twenty patients were included in this study and were aged 37-63 years (average +/- standard deviation: 48.8 +/- 5.86). The follow up was between 3 and 122 months (44.8 +/- 31.91). All hysteroscopic procedures were performed under general anesthesia, using local anesthetics (paracervical block) or short-term i.v. anesthesia, plus antibiotics. The procedures lasted 5 to 15 min (9.4 +/- 2.44). Five patients presented with minimal blood loss (< or =100 mL) and the rest had no blood loss. The hysteroscopic procedures had no adverse effects on the function of transplanted organs and there were no associated postoperative complications. Uterine bleeding was successfully regulated in all patients. CONCLUSION: Minimally invasive procedures and hysteroscopy of organ-transplanted patients provide a safe solution for the treatment of menorrhagia, submucosal myoma and thick endometrium in postmenopausal patients.

Neuroactive pregnanolone isomers during pregnancy.

The pregnanolone isomers (PI) allopregnanolone (3alpha-hydroxy-5alpha-pregnan-20-one), pregnanolone (3alpha-hydroxy-5beta-pregnan-20-one), isopregnanolone (3beta-hydroxy-5alpha-pregnan-20-one), epipregnanolone (3beta-hydroxy-5beta-pregnan-20-one), progesterone, and estradiol were measured in 138 pregnant women. The sampling was carried out from the first through the 10th month of pregnancy. Gas chromatography-mass spectrometry analysis and RIA were used for the measurement of steroid levels. The ratios of individual PI were similar to those found previously around parturition: about 25:10:7:1 for allopregnanolone, pregnanolone, isopregnanolone, and epipregnanolone, respectively. All the PI showed a significant increase during pregnancy, which was more pronounced in the 3alpha-steroids. The results indicated changing ratios between 3alpha- and 3beta-PI and between 5alpha- and 5beta-PI throughout pregnancy. The constant allopregnanolone/isopregnanolone ratio found through pregnancy weakened the hypothesis of the role of isopregnanolone in the onset of parturition. The ratio of estradiol (stimulating uterine activity) to 5alpha-PI and epipregnanolone exhibited significant changes during pregnancy in favor of estradiol up to the sixth or seventh month, in contrast to the constant estradiol/pregnanolone ratio. A pregnancy-stabilizing role of pregnanolone, counterbalancing the stimulating effect of estradiol on the onset of parturition, was suggested.