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1.
Clin Obstet Gynecol ; 64(1): 12-19, 2021 03 01.
Article in English | MEDLINE | ID: mdl-33239575

ABSTRACT

The precise etiology of the biochemical changes and the resulting constellation of symptoms seen in polycystic ovary syndrome (PCOS) has remained a mystery. Despite advances in our knowledge, the pathogenesis and alterations in the biochemical pathways underlying this disease are still not fully understood. PCOS is a multifactorial syndrome where a combination of genetics, lifestyle, and hormone abnormalities all play an intertwining role. This article will provide an in-depth look at the multitude of biochemical pathways that are dysregulated in PCOS and their relation to alterations in female physiology.


Subject(s)
Insulin Resistance , Polycystic Ovary Syndrome , Female , Humans , Life Style
2.
Clin Obstet Gynecol ; 64(1): 110-118, 2021 03 01.
Article in English | MEDLINE | ID: mdl-32740042

ABSTRACT

Polycystic ovary syndrome is a common endocrinopathy that has been associated with many medical conditions across nearly every specialty. This chapter reviews the current understanding of polycystic ovary syndrome and associated medical conditions.


Subject(s)
Polycystic Ovary Syndrome , Female , Humans
3.
Mil Med ; 183(5-6): e270-e271, 2018 05 01.
Article in English | MEDLINE | ID: mdl-29415160

ABSTRACT

Introduction: Smallpox, or vaccinia, has been eradicated worldwide as a disease; however, it may be weaponized and is thus a required immunization when military members deploy to certain parts of the world. Materials and Methods: We report two unusual cases of genital autoinoculation following smallpox vaccination. Results: Both patients' lesions resolved without sequelae within 20 d. Conclusions: We advocate for thorough education on this potential vaccination adverse event. These cases highlight the importance of a broad differential diagnosis when dealing with vulvar lesions, particularly in our military population.


Subject(s)
Smallpox Vaccine/adverse effects , Vaccinia/etiology , Vaginal Diseases/etiology , Adult , Female , Humans , Military Personnel , Smallpox/drug therapy , Smallpox/prevention & control , Smallpox Vaccine/therapeutic use , Vaccination/adverse effects , Vaccinia/virology , Vaginal Diseases/virology
4.
Int Urogynecol J ; 29(2): 223-228, 2018 02.
Article in English | MEDLINE | ID: mdl-28593365

ABSTRACT

INTRODUCTION AND HYPOTHESIS: The aim of this study was to evaluate urinary symptoms in the postpartum period after omission of the bladder flap at the time of primary cesarean delivery. METHODS: This was a single-blind parallel-group randomized comparison (bladder flap, no bladder flap) in women scheduled for a primary cesarean delivery at 37 weeks gestation or later. The primary outcome was urinary symptom scores at 6-8 weeks postpartum. Secondary outcomes included comparisons of preoperative and postoperative pelvic floor symptom scores and the proportions of symptom bother responses between the study groups. RESULTS: A total 43 women were available for analysis. Randomization was as follows: omission of the bladder flap (n = 22) and bladder flap (n = 21). Demographic characteristics and baseline pelvic floor symptom scores were similar between the groups. The primary outcome, urinary symptom scores at 6-8 weeks postpartum, did not differ significantly between the groups, but urinary symptom bother was significantly higher in women who received a bladder flap. Pelvic floor symptom scores improved significantly following delivery. CONCLUSIONS: Urinary symptom scores as measured by the UDI-6 did not differ between women randomized to bladder flap or omission of the bladder flap, but the proportion of women with urinary symptom bother was significantly higher among those who received a bladder flap.


Subject(s)
Cesarean Section/adverse effects , Lower Urinary Tract Symptoms/etiology , Postoperative Complications/etiology , Surgical Flaps/adverse effects , Urinary Bladder/surgery , Adult , Cesarean Section/methods , Female , Humans , Pelvic Floor/physiopathology , Postpartum Period , Pregnancy , Single-Blind Method
5.
Eur J Endocrinol ; 170(1): 121-9, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24114435

ABSTRACT

OBJECTIVE: Estrogen stimulates pulsatile secretion of GH, via mechanisms that are largely unknown. An untested hypothesis is that estradiol (E2) drives GH secretion by amplifying interactions among GH-releasing hormone (GHRH), somatostatin (SS), and GH-releasing peptide (GHRP). DESIGN: The design comprised double-blind randomized prospective administration of transdermal E2 vs placebo to healthy postmenopausal women (n=24) followed by pulsatile GHRH or SS infusions for 13 h overnight with or without continuous GHRP2 stimulation. METHODS: End points were mean concentrations, deconvolved secretion, and approximate entropy (ApEn; a regularity measure) of GH. RESULTS: By generalized ANOVA models, it was observed that E2 vs placebo supplementation: i) augmented mean (13-h) GH concentrations (P=0.023), GHRH-induced pulsatile GH secretion over the first 3 h (P=0.0085) and pulsatile GH secretion over the next 10 h (P=0.054); ii) increased GHRP-modulated (P=0.022) and SS-modulated (P<0.001) GH ApEn; and iii) did not amplify GHRH/GHRP synergy during pulsatile GH secretion. By linear regression, E2 concentrations were found to be positively correlated with GH secretion during GHRP2 infusion (P=0.022), whereas BMI was found to be negatively correlated with GH secretion during GHRH (P=0.006) and combined GHRH/GHRP (P=0.015) stimulation. E2 and BMI jointly determined triple (combined l-arginine, GHRH, and GHRP2) stimulation of GH secretion after saline (R²=0.44 and P=0.003) and pulsatile GHRH (R²=0.39 and P=0.013) infusions. CONCLUSION: In summary, in postmenopausal women, E2 supplementation augments the amount (mass) and alters the pattern (regularity) of GH secretion via interactions among GHRH, SS, GHRP, and BMI. These outcomes introduce a more complex model of E2 supplementation in coordinating GH secretion in aging women.


Subject(s)
Estradiol/therapeutic use , Estrogen Replacement Therapy , Growth Hormone-Releasing Hormone/metabolism , Human Growth Hormone/metabolism , Overweight/metabolism , Pituitary Gland, Anterior/drug effects , Somatostatin/metabolism , Aged , Arginine/administration & dosage , Body Mass Index , Double-Blind Method , Estradiol/administration & dosage , Estradiol/adverse effects , Estradiol/pharmacokinetics , Estrogen Replacement Therapy/adverse effects , Feedback, Physiological/drug effects , Female , Growth Hormone-Releasing Hormone/administration & dosage , Human Growth Hormone/blood , Humans , Infusions, Intravenous , Middle Aged , Oligopeptides/administration & dosage , Oligopeptides/metabolism , Overweight/blood , Overweight/physiopathology , Pituitary Gland, Anterior/metabolism , Pituitary Gland, Anterior/physiopathology , Postmenopause , Pulsatile Flow/drug effects , Somatostatin/administration & dosage , Transdermal Patch
7.
Fertil Steril ; 95(1): 417-9, 2011 Jan.
Article in English | MEDLINE | ID: mdl-20889153

ABSTRACT

This case-control study shows a strong association between migraine history and development of ovarian hyperstimulation syndrome (OHSS). We hypothesize there may be a similar gene variant that predisposes women to both migraines and OHSS and identification will lead to optimal therapy, not only for OHSS, but also for women who suffer from migraines.


Subject(s)
Dopamine/physiology , Infertility, Female/epidemiology , Migraine Disorders/epidemiology , Ovarian Hyperstimulation Syndrome/epidemiology , Ovulation Induction/adverse effects , Ovulation Induction/statistics & numerical data , Adult , Case-Control Studies , Databases, Factual , Female , Humans , Infertility, Female/physiopathology , Infertility, Female/therapy , Logistic Models , Migraine Disorders/physiopathology , Ovarian Hyperstimulation Syndrome/physiopathology , Predictive Value of Tests , Risk Factors
8.
Fertil Steril ; 92(3): 1169.e15-1169.e17, 2009 Sep.
Article in English | MEDLINE | ID: mdl-19608177

ABSTRACT

OBJECTIVE: To describe an outpatient treatment protocol for ovarian hyperstimulation syndrome (OHSS) that results in rapid normalization of symptoms with minimal side effects. DESIGN: Case series. SETTING: Midwestern academic reproductive endocrinology division. PATIENT(S): Four consecutive patients, diagnosed with OHSS, who presented after oocyte retrieval but before embryo transfer. INTERVENTION(S): All embryos were frozen and each patient was treated with the same dopamine agonist and GnRH antagonist protocol. MAIN OUTCOME MEASURE(S): Daily weights, days to resolution of clinical symptoms, side effects of the treatment protocol, and whether or not acute care or hospitalization was necessary. RESULT(S): The most rapid weight loss was within the first 5 days of treatment. The average time to resolution of clinical symptoms was 5.75 days. No side effects were reported and no patients required acute care or hospitalization. CONCLUSION(S): Dopamine agonists and GnRH antagonists, when given together at the time of diagnosis of OHSS, appear to work rapidly and effectively to diminish the clinical symptoms of the disease. The potential benefit of finding an outpatient treatment for OHSS with rapid onset and minimal side effects warrants further investigation into this protocol.


Subject(s)
Dopamine Agonists/therapeutic use , Ergolines/therapeutic use , Gonadotropin-Releasing Hormone/analogs & derivatives , Gonadotropin-Releasing Hormone/antagonists & inhibitors , Ovarian Hyperstimulation Syndrome/drug therapy , Adult , Cabergoline , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Gonadotropin-Releasing Hormone/therapeutic use , Humans , Treatment Outcome
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