Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses.

The aim of this study was to evaluate the pathological features and pregnancy outcomes of pregnancy-associated adnexal masses, between 2001 and 2007. During this period, 0.3% of deliveries (35) were associated with adnexal masses. Torsion or rupture of the adnexal mass complicated pregnancy in 17.1% (6/35) of the cases. The most common histopathological diagnosis was dermoid cyst in 40% of cases (14/35), and 8.5% of cases (3/35) were malignant, including borderline ovarian lesion. None of the patients had an adverse pregnancy outcome due to emergency laparotomy. Pregnancy-associated persistent adnexal masses with large size, complex or solid appearance and bilateral location can be managed surgically, which can decrease the risk of complications, such as torsion or rupture and which can diagnose malignancies early.

The effect of resveratrol on prevention of the development of postoperative adhesions in a rat model.

OBJECTIVE: Our aim was to investigate the anti-adhesion potential of resveratrol, a phytoestrogen naturally found in wine, in a rat uterine horn model. METHODS: Lesions were created by laparotomy in the uterine horn of 70 rats, randomized before the operation into seven groups consisting of ten animals each: (1) control group, no adjuvant therapy; (2) intraperitoneal (IP) application of the resveratrol dilution vehicle, 10 mg/kg, before closing the laparotomy; (3) subcutaneous (SC) injection of dilution vehicle, 10 mg/kg, 30 min before the operation; (4) IP application of resveratrol, 10 mg/kg, before closing the laparotomy; (5) SC injection of resveratrol, 10 mg/kg, 30 min before the operation; (6) IP application of resveratrol, 10 mg/kg, before closing the laparotomy and continued SC daily for 5 days; and (7) SC injection of resveratrol, 10 mg/kg, 30 min before the operation and continued SC daily for 5 days. On the 14th postoperative day adhesion scores were determined. Levels of thiobarbituric acid-reactive substances and total antioxidant capacity (TAC) were also measured. RESULTS: In animals treated with repeated SC resveratrol, adhesions were graded as significantly less severe than in the vehicle control group or the groups treated with resveratrol IP or IP plus SC. TAC of control group rats was significantly lower than that of animals treated with repeated SC resveratrol. CONCLUSION: Repeated SC resveratrol significantly reduces adhesion formation.

Blood loss and power Doppler ultrasound characteristics of uterine artery blood flow after 2 levels of bilateral internal iliac artery ligation before extensive myomectomies.

OBJECTIVE: To compare the blood loss and power Doppler ultrasonographic characteristics of uterine artery blood flow after 2 different techniques of internal iliac artery ligation prior to extensive myomectomy. STUDY DESIGN: A randomized, double-blind study was conducted in a tertiary referral center. Either bilateral ligation of the anterior branch of the internal iliac artery (group I, n = 14) or ligation 2 cm proximal to its bifurcation (group II, n = 14) was performed. Intraoperative blood loss was calculated. Power Doppler ultrasonography and magnetic resonance angiography were used to evaluate blood flow in the uterine arteries. RESULTS: The mean number of leiomyomas excised was 9.5 +/- 3.4 in group I and 8.7 +/- 2.6 in group II (p = 0.5). The mean blood loss was similar in groups I and II (350 +/- 201 mL and 308 +/- 129 mL, respectively, p = 0.5). As compared to preoperative values, the decrease in the resistance index and mean arterial velocity was significant in both the right and left uterine arteries in group I. Only the decrease in mean arterial velocity in the right uterine artery was significant in group II. CONCLUSION: Ligation of the anterior branch of the internal iliac artery provides a greater decrease in uterine artery resistance and velocity without causing any difference in blood loss as compared to main trunk ligation.

Serum amyloid A levels are increased in pre-eclampsia.

AIM: The purpose of this study was to examine serum amyloid A (SAA) levels in normal pregnant and pre-eclamptic women. METHODS: SAA levels were measured in 25 normotensive and 25 pre-eclamptic pregnant women by enzyme linked immuno-sorbent assay. RESULTS: In pre-eclampsia, SAA level and C-reactive protein (CRP) averaged 28.2 (7.2-135) ng/l and 21 (6.13-91) mg/l, respectively, which were significantly higher than those of normal pregnancy (7.8 [4.65-24.6] ng/l and 6.05 [0.3-19] mg/l, respectively) (p < 0.05). In addition, SAA level was positively correlated to CRP (r = 0.468, p < 0.05). CONCLUSION: Marked increases of both SAA level and CRP in pre-eclampsia, and their inter-relation, may at least in part contribute to the pathogenesis of pre-eclampsia.

Increased adenosine deaminase in hydatidiform mole.

BACKGROUND: The aim of the current study was to investigate levels of adenosine deaminase in plasma of patients with hydatidiform mole. METHODS: Plasma adenosine deaminase levels were determined in 17 women with normal pregnant course, in 17 women with hydatidiform mole, and in 17 non-pregnant healthy volunteers. RESULTS: Mean adenosine deaminase activity in the hydatidiform mole group was 121.5+/-24.8 U/L, significantly higher than in the pregnant control (7.8+/-6.5 U/L; p<0.0001) and non-pregnant control groups (6.4+/-7.4 U/L; p<0.0001). A cutoff level of 40.5 U/L was found, with both sensitivity and specificity of 100%. CONCLUSIONS: Adenosine deaminase may play a role in the development of hydatidiform mole.

Effect of postpartum counseling on postpartum contraceptive use.

OBJECTIVE: The aim of this study was to evaluate the effect of postpartum counseling on postpartum contraceptive use. METHODS: One hundred and forty-three women who delivered between 1 January 2004 and 31 September 2004 and counseled about postpartum contraception were included in the study. The participants were interviewed by telephone. Age, gravidity, parity, and mode of delivery of the participants were recorded. Their method of contraception before pregnancy, their decision on the contraceptive method after counseling and the method actually used were asked. RESULTS: Just after postpartum counseling, 47 women (32.9%) decided to use the intrauterine device (IUD), 23 (16.1%) condoms, 16 (11.2%) progestin injections, 7 (4.9%) oral contraceptives, and 7 (4.9%) coitus interruptus for contraception. Thirty-six women (25.2%) did not decide on any method of use. At the time of the telephone interview the actual method used was learned. Fifty-one women (35.7%) were using coitus interruptus, 45 women (31.5%) condoms, and 14 (9.8%) the IUD. Sixteen women (11.2%) were reported as not using any methods. CONCLUSION: In spite of postpartum counseling, a high majority of the women appeared to use traditional and less effective contraceptive methods.

Effects of intranasal 17beta-estradiol and raloxifene on lipid profile and fibrinogen in hypercholesterolemic postmenopausal women: a randomized, placebo-controlled clinical trial.

AIM: To compare the effects of 17beta-estradiol given intranasally (intranasal E2) and raloxifene on serum lipid profile and fibrinogen in hypercholesterolemic postmenopausal women. METHODS: The study population consisted of 46 women after menopause. The placebo group (n = 11) was given calcium, while the intervention groups were given intranasal E2 (Aerodiol; Servier, Chambray-les-Tours, France) (n = 16) or raloxifene (Evista; Lilly SA, Madrid, Spain) (n = 19). Blood lipids and fibrinogen were compared between groups at baseline and after 3 months of treatment. RESULTS: The group receiving intranasal E2 showed a significant decrease in triglyceride levels (p<0.05) and a marked increase in high-density lipoprotein cholesterol levels (p<0.05). No changes in lipid profile were observed in the raloxifene and placebo groups. Raloxifene caused a significant decrease in fibrinogen levels (p<0.05). CONCLUSION: Intranasal E2 exerts significant effects on lipid profile in hypercholesterolemic postmenopausal women. Raloxifene has a greater impact on fibrinogen than intranasal E2 application.

Relationship between meconium staining, umbilical cord plasma motilin level and infantile colic.

OBJECTIVE: To assess the effects of meconium-stained amniotic fluid and umbilical cord plasma motilin levels on the development of infantile colic. STUDY DESIGN: One hundred forty pregnant women referred to our department for labor care were enrolled in the study. All subjects were laboring women with singleton, vertex-presenting fetuses, with a gestational age of > or = 36 weeks. After each infant with meconium-stained amniotic fluid was born, the following 2 infants without meconium were selected as controls. Umbilical cord plasma motilin levels were measured in 47 infants with meconium-stained amniotic fluid and 93 infants with no meconium. At the end of the third month of the infants' lives, the development of infantile colic was evaluated. Umbilical cord serum specimens were collected from 45 infants with colic and 95 infants without colic. Statistics included Student's t, chi2 and Mann-Whitney U tests, as appropriate. Multivariate analysis was performed. RESULTS: There was no correlation between the presence of meconium-stained amniotic fluid and the development of infantile colic. No association was found between umbilical cord plasma motilin levels and the development of infantile colic. Neonatal intensive care unit admission was found to be a significant risk factor for the development of infantile colic. CONCLUSION: Meconium-stained amniotic fluid and umbilical cord plasma motilin levels do not affect the development of infantile colic.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?

AIM: Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). METHODS: The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver-operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk. RESULTS: There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%. CONCLUSION: As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.

Gemcitabine plus carboplatin in platinum-sensitive recurrent ovarian carcinoma.

Although the general intent of treatment for patients with recurrent ovarian cancer is palliative, and cure does not seem to be a realistic objective in this setting, median overall survival is greater than 12 months in platinum-sensitive recurrent ovarian cancer. Patients with ovarian cancer can now expect that the time from first relapse of their disease to death will be longer than the period from diagnosis to that first relapse. There is current evidence from prospective randomized trials that carboplatin combined with either paclitaxel or gemcitabine confers a progression-free survival advantage over platinum monotherapy for patients with platinum-sensitive relapsed ovarian cancer. Since the efficacy of paclitaxel/platinum and gemcitabine/carboplatin regimens appears to be comparable based on similar progression-free survival (both combinations confer a 3-month advantage), toxicity profiles should be taken into account when deciding on the combination to be used. The gemcitabine/carboplatin combination should be preferred in patients with underlying peripheral neuropathy. Since alopecia associated with paclitaxel can diminish the overall quality of life, the gemcitabine plus carboplatin combination may be preferable for patients in whom alopecia is a major consideration. This review provides an update on the role of the gemcitabine/carboplatin combination in platinum-sensitive recurrent ovarian cancer.

Elevated nucleated red blood cell count: a population-based study.

OBJECTIVE: To assess the prevalence and causes of elevated nucleated red blood cell (NRBC) count. STUDY DESIGN: We conducted a 1-year, population-based surveillance study that included pregnant women and their infants from our medical center, which serves as a tertiary referral hospital. Outcome measures included NRBC count, gestational age, mode of delivery, birth weight, Apgar scores, cord blood gasses, rate of neonatal intensive care unit admission. Statistical analyses were performed with Mann-Whitney U-test, independent samples t test, chi2 test, Fisher's exact test and Spearman's correlation test, as appropriate. RESULTS: NRBC count obtained from 423 women had a median of 4 (0-163). A cutoff point of 13.5 for predicting fetal acidosis had the highest combined sensitivity (77.8%) and specificity (84%). Three hundred forty-nine neonates had a NRBC count < or = 13.5, whereas 73 had > 13.5. Logistic regression analysis revealed that preeclampsia (OR = 5.9, 95% CI = 2.8-12.3) remained the most prominent risk factor for elevated NRBC count. CONCLUSION: Elevated NRBC appears to be associated with preeclampsia.

Pelvic organ prolapse complicating third trimester pregnancy. A case report.

The concomitant phenomenon of a third trimester pregnancy with a significant degree of pelvic organ prolapse is extremely rare. We report on a patient with pelvic organ prolapse complicating third trimester pregnancy treated by concomitant cesarean hysterectomy and abdominal sacrocolpopexy. A 30-year-old woman, gravida 6, parity 5, was admitted to the hospital with uterine contractions in week 35 of gestation. Pelvic examination in the dorsal lithotomy position revealed a stage 3 pelvic organ prolapse. A cesarean hysterectomy was performed. After hysterectomy, the vaginal cuff was suspended to the periosteum overlying the sacral promontory. Cesarean hysterectomy might be a therapeutic option for women who have completed their families and are suffering from severe pelvic organ prolapse complicating third trimester pregnancy, particularly in developing countries where access to health care is limited.

Metabolic changes in pelvic lesions: findings at proton MR spectroscopic imaging.

OBJECTIVE: The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. MATERIALS AND METHODS: 17 patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. RESULTS: Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. CONCLUSION: MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.

Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study.

OBJECTIVE: To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS: Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS: Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION: The observed difference is the presence of lipid signal only in endometrial carcinoma.

Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis.

Small cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.

Oral misoprostol for the third stage of labor: a randomized controlled trial.

OBJECTIVE: To compare oral misoprostol with conventional oxytocics in the management of the third stage of labor. In a controlled trial, 1574 women were randomized into four groups, as follows: Group 1 received intravenous infusion of oxytocin 10 IU plus oral misoprostol 400 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 2 received oral misoprostol 400 micro g, followed by two doses of oral misoprostol 100 micro g 4 hours apart; group 3 received intravenous infusion of oxytocin 10 IU; and group 4 received intravenous infusion of oxytocin 10 IU plus intramuscular administration of methylergonovine maleate (Methergine) 0.2 mg. The incidence of postpartum hemorrhage and decrease in hemoglobin concentration from before delivery to 24 hours postpartum were the main outcome measures. RESULTS: The primary outcome measures were similar in groups 2 and 3. The incidence of postpartum hemorrhage was 9% in group 2, compared with 3.2% in group 1 and 3.5% in group 4 (P <.01, and P =.01, respectively). There were no significant differences among the four groups regarding hemoglobin concentrations. Significantly more women needed additional oxytocin in group 2, when compared with group 4 (5.9% versus 2.2%; P =.01). The proportion of women requiring additional methylergonovine maleate was 4.8% in group 2, compared with 0.7% in group 1 and 1% in group 4 (P <.01 and P =.01, respectively). CONCLUSION: Oral misoprostol alone is as effective as oxytocin alone for the prevention of postpartum hemorrhage; it is less effective than oxytocin plus methylergonovine maleate and oral misoprostol plus oxytocin.

Is rectal misoprostol really effective in the treatment of third stage of labor? A randomized controlled trial.

OBJECTIVE: The purpose of this study was to compare misoprostol 600 microg intrarectally with conventional oxytocics in the treatment of third stage of labor. STUDY DESIGN: In a controlled trial, 1606 women were randomly grouped to receive (1) oxytocin 10 IU plus rectal misoprostol, (2) rectal misoprostol, (3) oxytocin 10 IU, and (4) oxytocin 10 IU plus methylergometrine. The main outcome measures were the incidence of postpartum hemorrhage and a drop in hemoglobin concentration from before delivery to 24 hours after delivery. RESULTS: The incidence of postpartum hemorrhage was 9.8% in the group that received only rectal misoprostol therapy compared with 3.5% in the group that received oxytocin and methylergometrine therapy (P =.001). There were no significant differences among the 4 groups with regard to a drop in hemoglobin concentrations. Significantly more women needed additional oxytocin in the group that received only rectal misoprostol therapy, when compared with the group that received oxytocin and methylergometrine therapy (8.3% vs 2.2%; P <.001). The primary outcome measures were similar in the group that received only rectal misoprostol therapy and the group that received only oxytocin therapy. CONCLUSION: Rectal misoprostol is significantly less effective than oxytocin plus methylergometrine for the prevention of postpartum hemorrhage.