Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report.

Purpose Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported. Case Report A congested, multinodular myomectomy specimen was resected. Histologically, smooth muscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the Ki-67 index was of 2-3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence. Conclusions Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant.

Introdução O leiomioma dissecante na forma cotiledonoide é uma variante de leiomioma com padrões raros de crescimento. Além de demonstrá-los, vamos apontar outro aspecto anteriormente não relatado. Relato de Caso Uma amostra congestionada, multinodular de miomectomia foi excisada. Histologicamente, detectaram-se fascículos de músculos lisos com marcada vascularidade e extensa degeneração hidrópica. Contaram-se 2 mitoses por 10 campos de alta potência, e o índice Ki-67 foi de 2­3%. Encontramos células atípicas, bizarras, que não haviam sido relatadas anteriormente. Não foi observada necrose coagulativa. A paciente encontrava-se saudável e sem evidências de recorrência 36 meses após a cirurgia. Conclusão De aparência bruta e grosseira, os leiomiomas dissecantes na forma cotiledonoide têm natureza benigna. Até hoje, células atípicas não haviam sido relatadas nesse tipo de tumor. Apesar dos aspectos simplásticos, os leiomiomas dissecantes na forma cotiledonoide são entidades clínicas benignas. Cirurgiões e patologistas devem estar familiarizados com essa variante.

Cotyledonoid Dissecting Leiomyoma with Symplastic Features: Case Report / Leiomioma dissecante cotiledonoide com aspectos simplásticos: relato de caso

Abstract Purpose Cotyledonoid dissecting leiomyoma is a leiomyoma variant exhibiting unusual growth patterns. We aimed to demonstrate this, as well as to point out another feature that has not been previously reported. Case Report A congested, multinodular myomectomy specimen was resected. Histologically, smoothmuscle fascicles with marked vascularity and extensive hydropic degeneration were detected. A total of 2 mitoses per 10 high power fields were counted, and the Ki-67 index was of 2-3%. We encountered atypical bizarre cells that have not been previously reported. Coagulative necrosis was not present. The patient was alive and well 36 months after surgery, with no evidence of recurrence. Conclusions Albeit the gross aggressive appearance, cotyledonoid dissecting leiomyomas are benign in nature. To this day, atypical cells have not been reported in this type of tumor. Despite the presence of symplastic features, cotyledonoid dissecting leiomyomas are clinically benign entities. Surgeons and pathologists should be acquainted with this variant.

Resumo Introdução O leiomioma dissecante na forma cotiledonoide é uma variante de leiomioma com padrões raros de crescimento. Além de demonstrá-los, vamos apontar outro aspecto anteriormente não relatado. Relato de Caso Uma amostra congestionada, multinodular de miomectomia foi excisada. Histologicamente, detectaram-se fascículos de músculos lisos com marcada vascularidade e extensa degeneração hidrópica. Contaram-se 2mitoses por 10 campos de alta potência, e o índice Ki-67 foi de 2-3%. Encontramos células atípicas, bizarras, que não haviam sido relatadas anteriormente. Não foi observada necrose coagulativa. A paciente encontrava-se saudável e sem evidências de recorrência 36 meses após a cirurgia. Conclusão De aparência bruta e grosseira, os leiomiomas dissecantes na forma cotiledonoide têm natureza benigna. Até hoje, células atípicas não haviam sido relatadas nesse tipo de tumor. Apesar dos aspectos simplásticos, os leiomiomas dissecantes na forma cotiledonoide são entidades clínicas benignas. Cirurgiões e patologistas devem estar familiarizados com essa variante.

Development and Validation of Turkish Version of The Female Sexual Distress Scale-Revised.

INTRODUCTION: The sexually related personal distress becomes an obligation for the diagnosis of female sexual dysfunction (FSD). The Female Sexual Distress Scale-Revised (FSDS-R) was developed, extensively validated, and is among the most widely used tools to measure distress associated with impaired sexual function. AIM: This study aims to develop a Turkish version of the FSDS-R, to evaluate its psychometric reliability and validity, and to estimate the optimal cutoff score that corresponds best to the clinical diagnosis of sexual dysfunction. METHODS: Ninety-five participants were diagnosed with female sexual interest and arousal disorder (FSIAD), 25 participants were diagnosed with another FSD, and 128 participants were healthy. Alpha coefficients (α) were used as an indicator of internal consistency. Test-retest reliability over a 2-week period was estimated using intraclass correlation coefficients (ICCs). Correlation analysis conducted between the FSDS-R total score, the Female Sexual Function Index subscale, and total score was examined for convergent validity. Discriminant validity was assessed by comparing mean scores of the FSD and control groups in a between-groups analysis of variance. Receiver operating characteristic analysis was performed to determine optimal cutoff values of the Turkish version of Female Sexual Distress Scale-Revised (Tr-FSDS-R). MAIN OUTCOMES MEASURES: Sexuality-related distress measured by the Turkish version of the FSDS-R. RESULTS: Internal consistencies of the FSDS-R across the two assessments point for the three groups of women ranged from α = 0.87 to α = 0.99. ICCs ranged from 0.92 to 0.94 for baseline and day 15 for FSIAD, other FSD, and no FSD groups. One-factor unidimensional model explained 85.7% of the total variance of the Tr-FSDS-R items. The optimal cutoff score was found to be >11.5 to provide optimal sensitivity (97.9%) and specificity (83.2%). Significant differences in the FSDS-R scores were found between healthy women, women with hypoactive sexual desire disorder, and women with other types of FSD. CONCLUSION: The Turkish version of FSDS-R is a valid, reliable tool with well discriminative and psychometric validity for use in the Turkish female population and can be used as a screening questionnaire for females with sexual interest/arousal disorder. The score of ≥11.5 was proposed as a cutoff to detect the presence of sexually related personal distress in Turkish women with FSD.

Carcinoid tumor arising in a mature cystic teratoma: A case report.

Mature cystic teratomas are common benign tumors of the ovary. The most common form of malignant transformation is squamous cell carcinoma, however, malignant transformation is rarely observed and cases are usually asymptomatic. Carcinoid tumors are rare tumors of the neuroendocrine system. A number of the carcinoids result in clinical syndromes due to the secretion of vasoactive substances produced by the tumor. A 75-year-old woman suffering from groin pain was admitted to the Faculty of Medicine at Bezmialem Vakif University (Istanbul, Turkey). An adnexal mass was detected during the physical examination. Magnetic resonance imaging scans exhibited an 8×7-cm mass in the right ovary. Surgical excision of the mass was performed and histopathological examination revealed a mature cystic teratoma with three germ layers. An area consisting of nests and trabeculae was evident in the cyst wall. The pathological diagnosis was of an insular and trabecular variant of carcinoid tumor arising in a mature cystic teratoma. The patient did not present with carcinoid syndrome, and no recurrence was observed after 11 months of follow-up examinations.

Cerebral venous sinus thrombosis and posterior reversible encephalopathy syndrome in a preeclamptic woman.

Cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two rare diseases which may present with similar symptoms and signs. We report a case with coexisting PRES and CVST in a preeclamptic woman. A 24-year-old woman, G2 P1, at 33 wk and 5 d of pregnancy presented with headache. Her blood pressure was 180/120 mmHg and urinary test revealed +3proteinuria. Cesarean section was performed with indications of severe preeclampsia, intrauterine growth retardation and fetal distress. Cranial MR venography of the patient revealed thrombiin superior sagittal sinus, confluenssinuum, right transverse and right sigmoid sinus and diffusion MRI showed increased signal intensity (vasogenicoedema) in cortical and subcortical areas of parietooccipital and posterior frontal lobes.The patient was treated with magnesium sulfate and heparin successfully. After treatment period, control cranial MRI and diffusion MRI were normal. Thrombi within the sinuses were totally regressed. Albeit rare, these two diseases should be kept in mind especially in preeclamptic/eclamptic patients that present with neurological symptom and/or sign.

Female sexual distress in infertile Turkish women.

OBJECTIVE: To evaluate the effect of infertility on sexual distress in women attending the infertility clinic. MATERIALS AND METHODS: In a cross-sectional study we evaluated sexual distress among 88 women who attended the infertility clinic in our institute between January and June 2015. All women who were experiencing primary or secondary infertility during the study sampling were included in the sudy. Sexual distress was measured using the Female sexual distress scale-revised (FSDS-R), a cross-validated patient-reported outcomes measure. Correlations of FSDS-R with patient characteristics and laboratory measurements were calculated using Spearman's rank correlation tests. RESULTS: With the exceptions of the age of couples and serum anti-mullerian hormone (AMH) levels, no predictor of high sexual distress was found in the univariate analysis when comparing groups with regard to the FSDS-R cut-off score. The mean age of the sexually distressed women (33.6±5.8 years vs. 29.3±5.1 years) and their partners (35.4±4.8 years vs. 31.6±4.2 years) was significantly higher than those of the non distressed women, according to a FSDS-R score over 11 (p<0.05). The serum level of AMH was significantly lower in infertile women with high total sexual distress scores (1.4 vs. 7.6 ng/mL (p<0.001)). CONCLUSION: In infertile women, age of woman, age of partner, and serum AMH levels are related with the hope of women to have a child despite an association with sexual distress. Serum AMH, which is perceived as necessary for fertility, had a significant inverse correlation with levels of sexual stress.

Effect of vaginal electrical stimulation on female sexual functions: a randomized study.

INTRODUCTION: Female sexual dysfunction (FSD) is a common problem that may be encountered in the interruption of normal sexual functioning in the sexual response cycle. Women with a pelvic floor disorder who scored low on the Female Sexual Function Index (FSFI) showed an improvement in their sexual life following treatment by vaginal electrical stimulation (VES). AIM: The aim of this trial was to evaluate the effectiveness of VES in women with FSD without a predominant pelvic floor disorder or urinary incontinence. METHODS: Forty-two women with FSD were randomly allocated to VES and placebo groups. Pelvic floor muscle (PFM) assessment and the FSFI questionnaire were performed at baseline and after the completion of sessions. VES treatment was administered using a vaginal probe. The probe was inserted, and a medium-frequency (50 Hz) alternating current was administered for a duty cycle of 5 seconds on followed by a 5-second rest. MAIN OUTCOMES MEASURES: Primary outcome measure was the improvement in FSFI score. PFM assessments were performed according to the PERFECT scheme. RESULTS: Total FSFI scores improved significantly in both the VES group and the control group. Results show that in the VES group, there was an improvement in total score and FSFI domains that improved including arousal, desire, orgasm, and satisfaction. Similarly, control group domains that improved were desire, arousal, and orgasm. But there was no significant increase in satisfaction scores in the placebo group. No significant changes in pain or lubrication domains were seen in either group. Power, endurance, fast contractions, and repetitions were significantly improved in the VES group. CONCLUSIONS: The lack of significant differences between the placebo and VES groups, except the satisfaction domain, puts into question the effectiveness of electrical stimulation as a monotherapy in treating primary FSD without pelvic floor disorder.

Effect of GnRH antagonists on clinical pregnancy rates in ovulation induction protocols with gonadotropins and intrauterine insemination.

INTRODUCTION: Intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) was applied to selected infertile patients to determine the effect of gonadotropin-releasing hormone (GnRH) antagonists in IUI cycles, in which recombinant follicle-stimulating hormone (rFSH) had been used for COH. METHODS: This study was conducted between April 1, 2009 and June 10, 2009, and involved a total of 108 patients. These patients had primary or secondary infertility, which resulted in an indication for IUI, and they each received two cycles of ovarian stimulation treatment with clomiphene citrate. The patients were randomised into two groups--patients in group A received rFSH + GnRH antagonist (n = 45), while those in group B received only rFSH (n = 63). RESULTS: The mean age of the patients was 31.84 ± 3.73 years and the mean body mass index (BMI) was 24.40 ± 1.88 kg/m(2). The mean age and BMI of the patients in groups A and B were not significantly different. There was no significant difference in the mean total rFSH dose administered (988.33 IU in group A and 871.83 IU in group B). When compared to group B, the mean number of follicles that were > 16 mm on the human chorionic gonadotropin (HCG) trigger day was significantly higher in group A (1.58 and 1.86, respectively; p < 0.05). When the two groups were compared, there were no statistically significant differences in the number of cancelled cycles due to premature luteinisation (none in group A vs. two in group B) and the rate of clinical pregnancy (8.9% in group A vs. 7.9% in group B). CONCLUSION: No significant improvement in the clinical pregnancy rates was observed when GnRH antagonists were used in COH + IUI cycles, despite the significant increase in the number of follicles that were > 16 mm on HCG trigger day.

Can CA-125 predict lymph node metastasis in epithelial ovarian cancers in Turkish population?

OBJECTIVE: The role of single preoperative serum CA-125 levels in predicting pelvic or paraaortic lymph node metastasis in patients operated for epithelial ovarian cancer has been investigated. METHODS: 176 patients diagnosed with epithelial ovarian carcinoma after staging laparotomy between January 2002 and May 2010 were evaluated retrospectively. RESULTS: The mean, geometric mean, and median of preoperative serum CA-125 levels were 632,6, 200,29, and 191,5 U/mL, respectively. The cut-off value predicting lymph node metastases in the ROC curve was 71,92 U/mL, which is significant in logistic regression analysis (P = 0.005). The preoperative log CA-125 levels were also statistically significant in predicting lymph node metastasis in logistic regression analysis (P = 0.008). CONCLUSIONS: The tumor marker CA-125, which increases with grade independent of the effect of stage in EOC, is predictive of lymph node metastasis with a high rate of false positivity in Turkish population. The high false positive rate may obscure the predictive value of CA-125.

Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery.

OBJECTIVE: To compare the effects of 2 suturing techniques (single versus double layer) on healing of the uterine scar after a cesarean delivery. METHODS: In the present randomized, prospective study, 36 women with a term pregnancy who had an elective cesarean delivery were randomly assigned to closure of the uterine incision with a single-layer locked suture or with a double-layer locked/unlocked suture. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed by hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing. RESULTS: There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, the mean thickness of the residual myometrium covering the defect was 9.95 ± 1.94 mm after a double-layer closure and 7.53 ± 2.54 mm after a single-layer closure (P = 0.005). The mean healing ratio was significantly higher after a double-layer closure (0.83 ± 0.10) than after a single-layer closure (0.67 ± 0.15; P = 0.004). CONCLUSION: A double-layer locked/unlocked closure of the uterine incision at cesarean delivery decreases the risk of poor uterine scar healing.

Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage?

OBJECTIVE: This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage. METHODS: Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted. RESULTS: Clinical outcomes in the two groups - including mean estimated blood loss, major complication rate, and hospital length of stay - were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group B's mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001). CONCLUSION: Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.

To evaluate the prevalence and clinical outcomes using a one-step method versus a two-step method to screen gestational diabetes mellitus.

OBJECTIVE: The goal of this study is to compare the prevalence and clinical outcomes of a one-step with a two-step screening method, both of which are commonly used for the diagnosis of gestational diabetes mellitus (GDM). METHODS: Women who presented for GDM screening and who consented to participate in this study were randomized into two groups. The women in Group 1 (n = 386) were screened using a one-step method (2-h, 75 g oral glucose tolerance test (OGTT)) and in Group 2 (n = 400) by a two-step method (the 50 g glucose challenge test (GCT) followed by the 100 g OGTT). The pregnancies were then classified into three subgroups as follows: women who had negative 2-h 75 g OGTT results according to IADPSG criteria (IADPSG-negative), women with negative 50 g GCT results (GCT-negative) and women with positive 50 g GCT results but negative 3-h 100 g OGTT results according to C&C criteria (C&C-negative). RESULTS: The prevalence of GDM using the one-step and two-step methods was 14.5% and 6%, respectively. In adjusted multivariable regression models, women in the GCT-negative and the C&C-negative groups had greater risk of polyhydramnios than women in the IADPSG-negative group [adjusted prevalence risk ratios (aPR), 1.40; 95% confidence intervals (CI), 1.03-1.91; aPR, 2.76; 95% CI, 1.27-6.02, respectively]. Women in the C&C-negative group had greater risk of pre-eclampsia than women in the IADPSG-negative group (aPR, 3.30; 95% CI, 1.57-6.91). CONCLUSIONS: Women who were defined as having normal glucose tolerance by IADPSG had better perinatal outcomes than women who were defined as having normal glucose tolerance by GCT and women who were GCT-positive with a negative OGTT.

Different phenotypes of polycystic ovary syndrome in Turkish women: clinical and endocrine characteristics.

This study presents the differences in clinical, endocrine and metabolic parameters among different polycystic ovary syndrome (PCOS) phenotypes in Turkish women. Four hundred and ten women with PCOS were evaluated, while 97 healthy women served as controls. PCOS were defined by oligo-anovulation (OA), hyperandrogenism (HA) and polycystic ovaries on ultrasound (PCO). Patients were subdivided into four phenotypes: OA + HA + PCO (phenotype 1), OA + HA (phenotype 2), HA + PCO (phenotype 3), OA + PCO (phenotype 4). Phenotypes 1-4 were present in 47.1%, 13.2%, 21.2% and 18.5% of patients, respectively. They were also divided into three groups according to the BMI (<25 kg/m(2); 25≤ and ≤30 kg/m(2); and >30 kg/m(2)). ANOVA and Tukey post-hoc HSD tests were used. The LH levels and LH/FSH ratio were higher in phenotype 1 and 2 than phenotype 3. The LDL-C levels were higher in women with phenotype 1 and 4 than in women with phenotype 2. Women with BMI <25 kg/m(2) had higher levels of LH, LH/FSH ratio, and the HDL-C than other two groups. The levels of TG, LDL, fasting insulin and HOMA-IR increased with increasing BMI in four phenotypes. Results suggest that obesity seems to be the primary cause of metabolic disturbances in PCOS women.

First trimester maternal serum pregnancy-associated plasma protein-A is a predictive factor for early preterm delivery in normotensive pregnancies.

In this study, we investigated whether the concentrations of pregnancy-associated plasma protein-A (PAPP-A) or free ß-hCG (fßhCG) in the first trimester can identify women at increased risk of subsequent preterm delivery in the absence of hypertensive disorders. Preterm and early preterm deliveries are defined as those deliveries before completing 37 and 34 weeks, respectively. A total of 868 women were enrolled into this study. According to the level of the markers, the patients were evaluated in three groups: 1 - maternal serum level ≤ 5 th percentile, 2 - between 5th and 95th percentiles, 3 - ≥ 95 th percentile. In the group of patients with a PAPP-A level ≤ 5 th percentile [≤ 0.35 multiples of the median (MoM)], mean gestational age (GA) at delivery, mean birth weight and the number of the cases with early preterm delivery were significantly lower than the others. Mean level of PAPP-A was significantly lower in cases with early preterm than term deliveries (0.58 ± 0.32 versus 1.09 ± 0.69; p = 0.01). Maternal serum level of fßhCG did not show significant difference between these groups (0.84 ± 0.45 versus 1.17 ± 0.77; p = 0.15). Low levels of maternal serum PAPP-A (≤ 0.35 MoM) (Odds ratio = 7; 95% confidence interval 1.8-27.7; p = 0.0048) significantly predicted early preterm delivery in normotensive pregnancies. Women with low levels of PAPP-A at first trimester have a higher risk of early preterm delivery even in the absence of hypertensive disorders.

The effects of ranibizumab on surgically induced endometriosis in a rat model: a preliminary study.

OBJECTIVE: To examine the effect of ranibizumab on surgically induced endometriosis in rat models. STUDY DESIGN: Endometrial tissue was implanted onto the abdominal peritoneum of 20 rats that were randomized into 2 groups. The rats in group 1 (n = 9) were given 0.6 mg/kg ranibizumab on the 1st and 14th days after the second operation. The rats in group 2 (control group, n = 9) received no medication. All the rats were observed for a total of 28 days. RESULTS: At the end of the treatment, the mean volume and weight of the explants in group 1 (11.49 ± 6.87 mm(3) and 36.61 ± 17.84 mg) were significantly lower than that of the control group (190.6 ± 177.4 mm(3) and 187.3 ± 174.5 mg; both Ps < .01). Mean epithelial histologic scores were significantly lower in group 1 (1.11 ± 0.78) than that of the control group (2.33 ± 0.71; P < .01). When compared with the control group, vascular endothelial growth factor (VEGF) immunoreactivities in group 1 showed statistically significant reductions (1.67 ± 0.50; 2.67 ± 0.50; P < .01). CONCLUSION: Ranibizumab has significantly regressed the size of the endometriotic implants and caused atrophy of these lesions in rats by decreasing explant levels of VEGF.

Could serum ß-hCG levels and gestational age be the indicative factors for the prediction of the degree of trophoblastic invasion into tubal wall in unruptured ampullary pregnancies?

OBJECTIVE: To evaluate the predictive value of gestational age and maternal serum ß-hCG concentration for the determination of the depth of trophoblastic invasion into the tubal wall. METHODS: This is a retrospective trial conducted on women with a diagnosis of ampullary pregnancy (71) who were submitted to salpingectomy. Serum ß-hCG measurements were obtained at the initial admission of hospital. Histological investigation was performed by a single well-experienced pathologist who was blind to the clinical and laboratory characteristics of the patients. Ampullary pregnancy was classified histologically according to the depth of trophoblastic infiltration into tubal wall: trophoblast limited to the tubal mucosa (stage I), extended to muscularis layer (stage II) and complete tubal wall infiltration up to serosal layer (stage III). RESULTS: There was a significant difference in maternal serum ß-hCG concentrations regarding the histological stages of trophoblastic invasion. The serum ß-hCG concentrations that the best predicted for stage III trophoblastic invasion was 6,475 mIU/ml, with a sensitivity of 100 %, a specificity of 92 %. CONCLUSION: The depth of trophoblastic tissue infiltration into tubal wall is correlated with serum ß-hCG levels, but not with gestational age. These findings may explain the reason for conservative management failure of EP in women with high ß-hCG concentrations.

Vaginal versus sublingual misoprostol for second-trimester pregnancy termination and effect on Doppler measurements.

OBJECTIVE: To compare the efficacy of vaginal versus sublingual misoprostol for second-trimester pregnancy termination, and to evaluate the effect on the blood flow of the uterine and umbilical arteries. METHODS: Forty-nine patients were randomized to receive either 200 microg of vaginal misoprostol every 6 hours or 200 microg of misoprostol sublingually every 6 hours. Doppler velocimetry studies were assessed immediately before and 60 minutes after the administration of the first dose. Standard descriptive calculations, Mann-Whitney U, Wilcoxon, and chi(2) tests were performed. RESULTS: The mean interval between induction and onset of active labor, induction and delivery, and the duration of oxytocin administration were significantly shorter in the sublingual misoprostol group. Both routes of administration increased the Doppler indices for the uterine arteries; however, misoprostol via the sublingual route did not affect the umbilical arteries. CONCLUSION: Sublingual administration of misoprostol for second-trimester medical abortion results in a higher success rate and does not affect umbilical blood flow.

The effect of estradiol valerate and dienogest combination on serum homocysteine levels in postmenopausal women: a clinical trial.

Several studies have verified that hormone replacement therapy (HRT) has protective effects on postmenopausal women's cardiovascular condition. However, highly significant recent studies have reported that women treated with HRT have more cardiovascular events than untreated women. An elevated homocysteine level is one important risk factor for cardiovascular disease (CVD). As a good indicator of CVD risk, we examined the changes in plasma homocysteine levels of postmenopausal women treated with HRT. In our study, we administered estradiol valerate (2 mg) and dionegest (2 mg) to 34 postmenopausal women recruited randomly from our menopause clinic, and measured plasma homocysteine levels of patients at baseline and after 3 and 6 months of therapy. The changes in plasma homocysteine levels of treated patients were not statistically significant (p = 0.241). Our results indicate that 6 months of estradiol valerate and dionegest therapy does not change homocysteine levels in postmenopausal women.

Evaluation of the effects of various gestagens on insulin sensitivity, using homeostatic model assessment, in postmenopausal women on hormone replacement therapy.

The objective of the present study was to compare the effects of various gestagens on insulin sensitivity in postmenopausal women on hormone replacement therapy (HRT). This prospective study enrolled 156 postmenopausal women who had menopausal status for at least 6 months. Group 1 was treated with 17 beta-estradiol (E2; 2 mg) plus norethisterone acetate (NETA; 1 mg); Group 2 was given E2 (2 mg) plus medroxyprogesterone acetate (MPA; 2.5 mg); Group 3 was given E2 (2 mg) plus dydrogesterone (DG; 10 mg); and Group 4 was given E2 (2 mg) plus micronized progesterone (MP; 100 mg). Group 5 was the surgical menopausal group and was given only E2 (2 mg) continuously. All 156 subjects completed the 3-month follow-up on the trial. The patients were analyzed by using homeostatic model assessment (HOMA) for insulin sensitivity before treatment and 3 months after treatment, comparing the effects of various HRT regimens on insulin sensitivity. No significant differences were found in the baseline characteristics of the patients (p > 0.05). There were no significant differences in mean values of HOMA before HRT among the five groups (p > 0.05). There were statistically significant differences in mean values of HOMA only in Group 1 (E2 + NETA) and Group 3 (E2 + DG) after HRT (p > 0.05). E2 + NETA and E2 + DG were found to improve insulin sensitivity in postmenopausal women after 3 months of treatment, whereas E2 + MPA, E2 + MP and E2 only did not show such an effect in postmenopausal women.

Brain damage to the survivor within 30 min of co-twin demise in monochorionic twins.

Single fetal death in a twin pregnancy in the late second or early third trimester is associated with significant morbidity and mortality rate in the surviving co-twin, especially in monochorionic twin pregnancies. The common causes are twin-to-twin transfusion syndrome, chromosomal abnormalities, and congenital anomalies of the fetus or anomalies of the umbilical cord-placenta. Here we report a case of monochorionic twin pregnancy in which one fetus had a single umbilical artery (SUA) while the co-twin had two umbilical arteries. The twin with SUA died in utero at the 30th week of gestation and the other fetus was delivered by cesarean section immediately due to fetal distress diagnosed by cardiotocography. Disseminated intravascular coagulation and multicystic encephalomalacia have been observed in the surviving neonate. This case and review of the literature suggest that neurologic complication rates are also increased in monochorionic twin pregnancies with single fetal demise despite the immediate delivery as in our case.