Outcome of arterial embolization of uterine leiomyoma: case report.

OBJECTIVE: To describe the outcomes after uterine artery embolization treatment of leiomyoma. DESIGN: Case report. SETTING: Department of Gynecology - Federal University of São Paulo. PATIENT: a 34-year-old woman with a diagnosis of leiomyoma for two years. INTERVENTION: embolization of uterine arteries with 500 to 700-microm diameter polyvinyl alcohol particles. MAIN OUTCOME MEASURE: pregnancy and delivery. RESULTS: After embolization, the follow-up revealed a good clinical response with significant reduction in uterus and leiomyoma volume. Also, the patient became spontaneously pregnant, but the delivery was cesarean section due to placenta accreta.. CONCLUSION: Regardless of arterial embolization results for controlling uterine bleeding, this procedure might have some consequences on pregnancy outcome.

Bioaccessibility of total bound fumonisin from corn flakes.

Fumonisin B1 (FB1) is often found as a natural contaminant of corn and corn-based food. Several publications have demonstrated the presence of fumonisin bound to proteins and to other compounds of the matrix. In spite of the low oral bioavailability of FB1 in rats, pigs, chickens, cows, and monkeys, FB1 can cause agriculturally significant disease and possibly human cancer. The aim of this work was to determine the bioaccessibility of total bound FB1 (TB FB1) (percentage of TB FB1, released from corn flakes to the chyme) after in vitro digestion. Two samples of corn flakes washed with solvents were incubated with gastrointestinal tract solutions simulating saliva plus stomach and duodenal juices. After hydrolysis of the chyme with KOH, TB FB1 was determined as hydrolyzed FB1 (HFB1). The bioaccessibility of TB FB1 in chyme from corn flakes was 37-64%, indicating that these derivatives should be considered in evaluation of exposure to fumonisin.

Effect ofin vitro digestion on fumonisin B1 in corn flakes.

Low levels of fumonisins have been found frequently in corn based breakfast cereals and can occur bound to protein and other matrix components.In vitro digestion of two samples of corn flakes was carried out under "fed conditions." Fumonisins were measured as o-phthaldialdehyde/mercaptoethanol derivatives by LC-fluorescence. One sample of corn flakes (FN12) had high concentrations of fumonisin B1 (FB) (average 125 ng/g) and total bound FB1, (TB FB1) (average 92 ng/g) and the other (FN11) had a low level of free FB1 (average 29 ng/g) and no detectable TB FB1. After incubation of the samples with gastrointestinal tract solutions simulating saliva plus stomach and duodenal juices, chyme was analysed for FB1, hydrolyzed FB1 (HFB1) and partially hydrolyzed fumonisin B1 (PHFB1). The bioaccessibility (percentage of FB1 released from corn flakes into chyme) was 38-78% for incurred FB1 in FN12, 8-54% for incurred plus spiked FB1 in FN12, and 19-66% for incurred plus spiked FB1 in FN11. HFB1 and PHFB1 were not detected. If free FB1 was first extracted from sample FN12, no FB1 was detected in the chyme, indicating no contribution from TB FB1. Concentrations were corrected for method recovery of FB1 or, for bound FB1, partial method recovery of HFB1.

The benefits of finasteride for hirsute women with polycystic ovary syndrome or idiopathic hirsutism.

Finasteride has been used frequently in the treatment of prostate hyperplasia, but this drug inhibits 5alpha-reductase and for this reason could be useful for the treatment of hirsutism. The aim of this study was to evaluate the clinical and hormonal effects of finasteride on hirsute women with idiopathic hirsutism or polycystic ovary syndrome. Twenty-four women were randomly divided into two groups: those given placebo and those given finasteride 5 mg/day. The treatment period was 6 months. All patients were evaluated before the beginning of treatment (baseline) and after 3 and 6 months of treatment using clinical examination through Ferriman-Gallwey score, blood pressure, cardiac frequency and body mass index. Also, we collected blood for hormonal determination of levels of prolactin, 17alpha-hydroxyprogesterone, follicle stimulating hormone, luteinizing hormone, total and free testosterone, dehydroepiandrosterone sulfate, androstenedione and dihydrotestosterone. Furthermore, all patients were asked about their concerns and satisfaction with the treatment. The results showed that the Ferriman-Gallwey score in the 6th month of finasteride treatment was significantly lower than at baseline and the 3rd month of this drug treatment. The dihydrotestosterone level in the finasteride group was also significantly reduced compared to that in the placebo group. The other hormones did not show any statistical difference during the study. All the patients treated with finasteride perceived a reduction in hirsutism after 6 months. In conclusion, our data suggest that finasteride may be effective for the treatment of the hirsute woman with idiopathic hirsutism or polycystic ovary syndrome.

High implantation and pregnancy rates with transfer of human blastocysts developed in preimplantation stage one and blastocyst media.

OBJECTIVE: To evaluate the proficiency of preimplantation stage one (P1) and blastocyst media in supporting human blastocyst development and to document implantation and clinical pregnancy rates from the transfer of the normally developed blastocysts. DESIGN: Retrospective clinical study. SETTING: Private IVF unit of a university-affiliated center. PATIENT(S): Twenty-eight women aged 33.7 +/- 2.9 years who underwent IVF treatment for infertility. INTERVENTION(S): Bipronucleate oocytes obtained from IVF and intracytoplasmic sperm injection were cultured in vitro with P1 and blastocyst media for 96-120 hours. One to three embryos were transferred (2.1 +/- 0.2 for the patients who became pregnant and 1.5 +/- 0.3 for those who did not become pregnant). MAIN OUTCOME MEASURE(S): Total number and percentage of developed blastocysts, frequency of blastocysts of grades A and B, and implantation and pregnancy rates. RESULT(S): From 431 oocytes retrieved, 269 bipronucleate oocytes were cultured, producing 81 blastocysts that resulted in the transfer of 54 embryos in 27 procedures. Blastocysts developed in 39.7% +/- 5.5% of the pregnant group and 30.2% +/- 4.5% of the nonpregnant group. From 15 (15/27 = 55.6%) clinical pregnancies, 18 (18/54 = 33.3%) gestational sacs were visualized. The rate of implantation in the pregnant group was 58.1% (18/31). CONCLUSION(S): These results provide evidence for the benefits of extending human embryo culture with P1 and blastocyst media for all normally fertilized embryos in vitro.

Ovarian activity before and after gonadal suppression by GnRH-a in patients with polycystic ovary syndrome, hyperandrogenism, hyperinsulinism and acanthosis nigricans.

OBJECTIVE: To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and acanthosis nigricans. DESIGN: Controlled clinical study. SETTING: Tertiary academic medical center. PATIENTS: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. INTERVENTIONS: Morning blood samples in the follicular phase to determine the steroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. MAIN OUTCOME MEASURE: Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. RESULTS: Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. CONCLUSIONS: Patients with PCO, hirsutism and acanthosis nigricans present high levels of insulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.

Ovarian activity before and after gonadal suppression by GnRH-a in patients with polycystic ovary syndrome, hyperandrogenism, hyperinsulinism and acanthosis nigricans

Objective. To investigate the ovarian activity before and after gonadal suppression with GnRH-analog in patients with PCO, hyperandrogenism, hyperinsulinism and ancathosis nigricans. Design: Controlled clinical study. Setting: Tertiary academic medical center. Patients: Six patients with clinical findings of PCO, hirsutism and acanthosis nigricans. Interventions. Morning blood samples in the follicular phase to determine the seteroid levels, glucose and insulin curve, comparing to a control group. Administration for 2 consecutive months of a GnRH-analog, comparing, in the study group, the free testosterone levels before and after ovarian suppression. Main Outcome Measure. Determination of insulin levels in PCO, hirsutism and acanthotic patients and the free-testosterone levels before and after gonadal suppression. Results. Insulin levels were significantly higher in the study group when compared to normal women during the glycemic test. We also found a significant decrease in the free-testosterone levels after 2 months of gonadal suppression with GnRH-analog when compared to the initial time. Conclusions. Patients with PCO, hirsutism and acanthosis nicrigans present high levels of in sulin, suggesting an ovarian hyperesponsiveness, which is not sustained when gonadotrophic blockage was achieved.

Effect of estrogen-progestin hormonal replacement therapy on plasma antithrombin III of postmenopausal women.

BACKGROUND: This study was performed to evaluate antithrombin III levels in postmenopausal women receiving hormonal replacement treatment. METHODS: It is a prospective randomized study concerning 19 postmenopausal patients, aged 40 to 65 years, who received either continuous daily oral equine conjugated estrogen 0.625 mg (group A, N=10) or daily transdermal 17beta-estradiol 50 microg (group B, N=9). Medroxyprogesterone acetate (5 mg/day, 14 days monthly) was given to all patients. Blood samples were obtained before and after 3, 6, 9 and 12 months of treatment. Coagulation tests included Antithrombin III (functional method), prothrombin time, partial activated prothrombin time, thrombin time, factor V, fibrinogen, platelet count and euglobulin lysis time. Friedman analysis of variance and Mann-Whitney test were used for statistical analysis. RESULTS: Antithrombin III level was reduced (p<0.05) in group A but not in group B, although it remained within normal range. No changes were detected in the other coagulation tests. CONCLUSIONS: These data suggest that oral conjugated estrogen replacement reduces functional ATIII, whereas transdermal estradiol replacement therapy does not modify it.

Successful birth after intrafallopian transfer of microhatched embryos.

OBJECTIVE: To present a successful transfer of microhatched embryos to the fallopian tubes via microlaparoscopy. DESIGN: Case report. SETTING: Private practice affiliated with a medical university. PATIENT: A 40-year-old woman with primary infertility, mildly elevated baseline FSH levels, and a history of poor ovarian response to ovulation induction. Her husband had severe oligoospermia after vasectomy reversal. INTERVENTION(S): Late luteal leuprolide acetate to pituitary down-regulation followed by pure FSH, 300 IU, and hMG, 300 IU, daily for ovulation induction. Transvaginal oocyte retrieval, intracytoplasmic sperm injection, assisted embryo hatching, microlaparoscopic intrafallopian ET. MAIN OUTCOME MEASURE(S): Amniocentesis at the 14th week of gestation revealed a normal karyotype (46,XX), birth of a normal female infant (3700 g). RESULT(S): Establishment of a single, viable intrauterine gestation followed by a vaginal delivery at term. CONCLUSION(S): This case shows the possibility of using assisted-hatched embryos for laparoscopic intrafallopian tube transfer.

Polycystic ovary syndrome: clinical and laboratory evaluation.

OBJECTIVE: To evaluate clinically, and with laboratory, tests, women with polycystic ovary syndrome (PCO). PATIENTS: One hundred and twelve women with PCO were studied. METHODS: The following data was recorded: Current age; age at menarche; menstrual irregularity, occurrence of similar cases in the family; fertility, obstetric history; body mass index (BMI); and presence of hirsutism. Serum measurements of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, free testosterone, and dehydroepiandrosterone sulfate were taken. RESULTS: All patients presented either oligomenorrhea (31 percent), periods of secondary amenorrhea (9 percent), or both alterations (60 percent). The majority of the patients were infertile (75.6 percent). The LH/FSH ratio was higher than 2:1 in 55 percent of the patients and higher than 3:1 in 26.2 percent. The ultrasonographic aspect of the ovaries was considered to be normal in 31 percent. CONCLUSION: The main clinical feature of the PCO is the irregularity of menses since menarche, and that the laboratory tests would be important to exclude other disorders such as hyperprolactinemia or hyperandrogenemia caused by late-onset congenital adrenal hyperplasia.

Selective salpingography with an insemination catheter in the treatment of women with cornual fallopian tube obstruction.

The effectiveness of selective tubal cannulation using a simple and inexpensive tubal insemination catheter was evaluated in 23 infertile patients with cornual obstruction demonstrated by hysterosalpingography. Selective fluoroscopic tubal catheterization was accomplished in 95% of the patients with resulting tubal patency in 70% of the procedures (28 recanalizations out of 40 Fallopian tubes). Eight patients (34.8%, eight out of 23) became pregnant, six went on to full-term deliveries and two experienced spontaneous first-trimester abortions. One women conceived twice, and delivered a singleton pregnancy after the first recanalization and a twin gestation after the second salpingography. No complications were reported. The results of this study emphasize the ease, cost effectiveness and safety of this method, encouraging its use in patients with cornual Fallopian tube obstruction either as the sole therapeutic approach or in association with other assisted conception treatment alternatives.