Ovarian control of pituitary sensitivity of luteinizing hormone secretion to gonadotropin-releasing hormone in women with the polycystic ovary syndrome.

This study investigated the ovarian control of LH responsiveness to GnRH in anovulatory women with the polycystic ovary syndrome (PCOS). It is suggested that the enhanced pituitary sensitivity of LH secretion to GnRH in anovulatory women with PCOS is not due to a reduced production but rather to a defect in the interaction of ovarian factors on the hypothalamic-pituitary system.

Blood ghrelin, resistin, and adiponectin concentrations during the normal menstrual cycle.

OBJECTIVE: To investigate changes of ghrelin, resistin, and adiponectin levels in the circulation during the normal menstrual cycle. DESIGN: Longitudinal study. SETTING: The study was conducted at a university hospital. PATIENT(S): Eight healthy normally cycling women. INTERVENTION(S): The women were observed during a whole menstrual cycle. Daily blood samples were taken every morning, after overnight fasting, from day 2 of the cycle until the next menstrual period. MAIN OUTCOME MEASURE(S): Plasma acylated and unacylated ghrelin and serum resistin, adiponectin, FSH, LH, E(2), and P levels were measured in all blood samples. RESULT(S): In all women serum FSH, LH, E(2), and P levels, normalized to the midcycle peak LH value, showed the typical changes of the normal menstrual cycle. Acylated and unacylated ghrelin, resistin, and adiponectin levels did not change significantly during the whole menstrual cycle. CONCLUSION(S): The present study shows for the first time that plasma ghrelin and serum resistin levels do not change significantly during the normal menstrual cycle. It is also confirmed that serum adiponectin levels remain stable throughout the cycle. It is suggested that ovarian steroid dynamics during the cycle have no effect on the secretion of these substances.

Effect of ovarian hormones on serum adiponectin and resistin concentrations.

OBJECTIVE: To investigate the effect of ovarian hormones on adiponectin and resistin levels in women. DESIGN: Experimental study. SETTING: University hospital. PATIENT(S): Thirteen normally cycling women (7 in group 1 and 6 in group 2) and 8 postmenopausal women (group 3). INTERVENTION(S): Women of group 1 were investigated in a control cycle and in a subsequent cycle in which total abdominal hysterectomy plus bilateral salpingooophorectomy (TAH+BSO) was performed on day 3. In both cycles, the women received increasing doses of E(2) from days 3 to 5. Women of group 2 underwent TAH+BSO on day 3 without receiving any hormonal treatment. Women of group 3 received increasing doses of E(2) for 15 days. MAIN OUTCOME MEASURE(S): Adiponectin, resistin, and E(2) concentrations. RESULT(S): In group 1, serum adiponectin and resistin levels did not show any significant changes for the week following day 3 and were similar in the two cycles. In group 2, adiponectin and resistin levels were similar before and after TAH+BSO and remained stable during the first postoperative week. In group 3, no significant changes in adiponectin and resistin levels were seen during the 15 days of E(2) administration. CONCLUSION(S): Adiponectin and resistin values were not affected either by estrogen treatment or after ovariectomy in women. It is suggested that ovarian hormones are not involved in the regulation of adiponectin and resistin secretion in women.

Ruptured heterotopic interstitial pregnancy: rare case of acute abdomen in a Jehovah's Witness patient.

OBJECTIVE: To report a case of ruptured right heterotopic interstitial pregnancy diagnosed and managed laparoscopically by cornual resection. DESIGN: Case report. SETTING: University tertiary care hospital. PATIENT(S): A 29-year-old female Jehovah's Witness patient with first-trimester acute right lower quadrant abdominal pain. INTERVENTION(S): Emergency laparoscopy was performed, and the site of bleeding was first clamped with a laparoscopic grasper. The lateral tissue was then coagulated and simultaneously transected with the bipolar-cutting probe for control of hemorrhage. MAIN OUTCOME MEASURE(S): The early diagnosis of heterotopic interstitial pregnancy should enable a conservative approach, whether medical or surgical, to be undertaken when treating this rare and potentially fatal condition. RESULT(S): The treatment of a ruptured heterotopic interstitial pregnancy by laparoscopy was successful with cornual resection. CONCLUSION(S): Management of a ruptured interstitial pregnancy by laparoscopy was successful with cornual resection and minimal blood loss, and a coexiting intrauterine pregnancy continued satisfactorily.

Growth hormone, insulin-like growth factor I, and leptin interaction in human cultured lutein granulosa cells steroidogenesis.

OBJECTIVE: To investigate the effect of leptin on the actions of growth hormone (GH) and insulin-like growth factor-I (IGF-I) in ovarian steroidogenesis in vitro. DESIGN: In vitro cell culture study. SETTING: Research laboratory of a university hospital. PATIENT(S): Luteinized granulosa cells (GC) were obtained from 20 healthy women undergoing ovarian stimulation for IVF treatment. INTERVENTION(S): Granulosa cells were cultured in serum free conditions for 72 hours with either GH or IGF-I, or their combination, in the absence or presence of leptin (1, 10, and 100 ng/mL). MAIN OUTCOME MEASURE(S): At 24 and 72 hours of the culture estradiol (E(2)) and progesterone (P) concentrations were measured in culture supernatants by enzyme immunoassays. RESULT(S): Leptin at the doses of 1 and 10 ng/mL significantly stimulated, whereas at the dose of 100 ng/mL it significantly suppressed E(2) and P production as compared to control. Estradiol production was significantly stimulated by both GH (72 hours) and IGF-I (24 and 72 hours) and that of P only by IGF-I (72 hours). Leptin at the low doses enhanced, whereas at the high dose it suppressed the effect of GH or IGF-I on E(2) and P synthesis. CONCLUSION(S): These results demonstrate for the first time that leptin can modulate the effect of GH on steroids production by human luteinized GC in culture.

Nocturnal hypertension is associated with an exacerbation of the endothelial damage in preeclampsia.

BACKGROUND: Non-dipping pattern of circadian blood pressure in preeclampsia is associated with an increased risk of cardiovascular disease. The pathogenetic mechanisms of this relationship are still unclear. We investigated whether non-dipping in preeclampsia could relate to endothelial activation or damage. METHODS: Participants, 20 women with normal pregnancy (mean age 29.9 +/- 5.7 years) and 31 women with preeclampsia (mean age 29.1 +/- 5.1 years), underwent 24-hour ambulatory blood pressure monitoring. Plasma levels of von Willebrand factor (vWf), marker of endothelial damage and of soluble adhesion molecules (sVCAM-1, sICAM-1), and markers of endothelial activation were determined using commercially available enzyme-linked immunoassays. RESULTS: Based on whether the nocturnal mean arterial pressure (MAP) relative to the daytime MAP declined by less than 10%, 21 women with preeclampsia were categorized as non-dippers. Compared to healthy pregnant women, patients with preeclampsia showed significantly enhanced levels of vWf (206.9 +/- 40.6 vs. 123 +/- 24 IU/dl;p<0.01) and sVCAM-1 (2,269 +/- 426 vs.1,159.8 +/- 340 ng/ml; p < 0.01). In addition, significantly higher levels of vWf (224.5 +/- 34.9 vs. 170 +/- 23 IU/dl; p < 0.01) and sVCAM-1 (2,405 +/- 421.4 vs. 1,983 +/- 276.7 ng/ml; p = 0.007) were determined, when women with preeclampsia and nocturnal hypertension (non-dippers) were compared to dippers. The results were similar even after adjustment for severity of preeclampsia. In contrast, neither preeclampsia nor dipping status had an effect on sICAM-1 levels. CONCLUSION: Nocturnal hypertension in preeclampsia is associated with elevated levels of molecules related to endothelial damage. Endothelial damage is a recognized pathogenetic factor for atherosclerosis and history of preeclampsia is a risk factor for cardiovascular disease. In this context, possible clinical implications of our findings deserve further investigation.

Massive vulvar edema in a woman with preeclampsia: a case report.

BACKGROUND: Massive vulvar edema in a woman with preeclampsia preceded the development of massive ascites and impending eclampsia. CASE: A 17-year-old preeclamptic, primiparous woman was admitted with preeclampsia and massive vulvar edema. Other causes were excluded. The vulvar edema increased as the blood pressure and ascites increased, and a severe headache developed. Cesarean section for increasing preclampsia was performed. In the puerperium, the blood pressure improved and vulvar edema resolved. The clinical picture of the vulvar edema correlated with the severity of the preeclampsia. CONCLUSION: The presence of vulvar edema in women with preeclampsia should indicate immediate admission to the hospital. These patients must be considered as at high risk, and close monitoring must be instituted. In our case, vulvar edema preceded massive ascites development. We assume a common development mechanism for these signs in preeclampsia, due mainly to increased capillary permeability and hypoalbuminemia. The attending physician must be prepared for immediate delivery and possible preeclampsia complications in these patients.

Uterine perforation as a rare complication of attempted pregnancy termination with misoprostol: a case report.

BACKGROUND: Abortion induced by drugs is now a viable alternative to surgically induced abortion, but it can cause severe complications. CASE: Products of conception were found in the peritoneal cavity after administration of misoprostol. CONCLUSION: The administration of misoprostol for pregnancy termination should be performed carefully in women with uterine wall defects.

Novel serum inflammatory markers in patients with adnexal mass who had surgery for ovarian torsion.

OBJECTIVE: To determine the diagnostic value of preoperative levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8), and E-selectin in patients with an adnexal mass who had surgery for ovarian torsion. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Fifty consecutive women with adnexal mass who were admitted with a diagnosis of ovarian torsion. INTERVENTION(S): All had a single preoperative measurement of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA. MAIN OUTCOME MEASURE(S): To determine if a single preoperative serum sampling of IL-6, IL-8, TNF-alpha, and E-selectin by ELISA can diagnose ovarian torsion. RESULT(S): Thirteen patients had proven torsion of the ovary. Serum levels of IL-6 were significantly higher in the 13 patients with proven ovarian torsion compared with the 37 without ovarian torsion. Patients with IL-6 serum values > or =10.2 pg/mL had a 16 times higher risk of having ovarian torsion. No significant difference was found in TNF-alpha, IL-8, and E-selectin between the two groups. CONCLUSION(S): The IL-6 levels might assist in the prompt diagnosis of ovarian torsion and allow a timely surgical intervention.

Recombinant human erythropoietin in a triplet pregnancy: a case report.

BACKGROUND: Women carrying triplets are at greater risk for both anemia, due to the increased demands of the developingfetuses, and peripartum hemorrhage. Jehovah's witnesses are a unique obstetric population since women of this faith refuse blood transfusion. CASE: A Jehovah's Witness with a triplet pregnancy was successfully administered recombinant human erythropoietin (rHuEpo), 200 IU/kg 3 times per week subcutaneously, in order to correct her peripartum anemia. No side effects were observed during rHuEpo therapy, and the patient delivered healthy triplets. CONCLUSION: rHuEpo can be safely administered, with a beneficial effect in pregnancy, and seems to be an effective option in preventing transfusions as demonstrated in this case in a Jehovah's Witness.