Estro-progestin and progestogen intake: What's the impact on hysteroscopic imaging?

Background: In current literature there is no report aimed to evaluate the effects of exogenous steroids on hysteroscopic imaging. Objectives: To evaluate the hysteroscopic features of endometrium in women undergoing female hormones administration. Materials and Methods: We reviewed video-records of hysteroscopies carried-out in women taking estro-progestins (EP), progestogen (P) and Hormonal Replacement Therapy (HRT). All women underwent biopsies resulting in atrophic, functional, or dysfunctional pathological reports. Main outcome measures: Description of hysteroscopic pictures related to each schedule of therapy. Results: The study included 117 women. We evaluated 82, 24 and 11 women treated by EP, P and HRT, respectively. In EP users, imaging indistinguishable from physiological pictures was found when high oestrogen dosage and low-potency progestogen as 17-OH progesterone derivatives were administered. By enhancing progestogen potency with 19-norprogesterone and 19-nortestosterone derivatives we observed a promotion of progestogen differentiation such as polypoid-papillary pseudo-decidualisation, spiral artery differentiation, inhibition of gland-proliferation and endometrial atrophy. In P users we distinguished two patterns, depending on continuous or sequential schedules. Continuous therapy resulted in atrophic or proliferative-secretory features whereas sequential ones led to endometrial overgrowth reflecting stromal pseudo-decidualisation. Women undergoing HRT showed atrophic features in combined continuous and polypoid overgrowth in sequential schedules. In women taking Tibolone we found pictures ranging from atrophic to hyperplastic appearances. Conclusions: Exogenous steroids lead to significant endometrial moulding. Depending on schedule, hysteroscopic-view appears predictable and often showing overgrowths mimicking proliferative pathologies. In this case biopsy is recommended but in common practice physicians should gain awareness with hysteroscopic pictures induced from hormone administration. What is new?: Systematic assessment of hysteroscopic pictures during estro-progestins intake.

Fabry disease in Argentina: an evaluation of patients enrolled in the Fabry Registry.

AIMS: Fabry disease (FD) is an X-linked inborn error of metabolism caused by alpha-galactosidase A deficiency. The Fabry Registry is an ongoing, global observational database that compiles clinical data from patients with FD. METHODS: Demographic and baseline clinical characteristics of Fabry Registry patients enrolled in Argentina were analysed and compared with patients enrolled in the rest of the world (ROW). Baseline clinical parameters included chronic kidney disease (CKD) stage, urine protein-to-creatinine ratio and left ventricular posterior wall thickness. Only data from untreated patients were included. RESULTS: As of 1 October 2010, 3752 patients were enrolled in the Registry, 70 patients from Argentina and 3682 from the ROW. Argentinean male subjects were younger than Fabry Registry male subjects enrolled in ROW: mean current age 32.5 years vs. 39.0 years for men (p = 0.0257 by t-test). The current age (mean ± standard deviation) of female subjects enrolled in Argentina was not significantly different from that of female subjects enrolled in the ROW: 40.1 ± 17.28 vs. 43.2 ±17.95 years respectively (p = 0.2967). Overall, a smaller percentage of patients from Argentina received ERT compared with patients in the ROW (54% vs. 58% respectively). When evaluated by gender, more men and fewer women in Argentina received ERT compared with ROW (85% vs. 79% for men and 27% vs. 38% for women). A larger proportion of patients in ROW had severe CKD (stage 4 or 5) compared with Argentina (9.8% vs. 0%), most likely because of the older age of the ROW population. CONCLUSIONS: The enrolment of Argentinean patients into the Fabry Registry has steadily increased, as has the inclusion of female and paediatric patients with FD. The medical community in Argentina should be aware of FD in these populations, as awareness will facilitate prompt diagnosis and initiation of treatment, thus leading to improved outcomes.

[The medical treatment of condylomatosis of the lower genital tract. A multicenter outpatient study]. / Trattamento medico della condilomatosi del basso tratto genitale. Studio policentrico ambulatoriale.

Beta-interferone (Frone, Serono) has been used to treat 56 patients with clinical diagnosis of genital condylomatosis in quantity of 3 million UI/die. Controls have been effected at 3 months since the end of therapy. 30 patients were cured after 3 months of therapy, while at 6 months follow-up we have reported a complete regression in 78.6% of cases.

Cervical changes throughout pregnancy as assessed by transvaginal sonography.

OBJECTIVE: To evaluate changes in cervical dimensions by transvaginal ultrasound in non-randomly selected pregnant women. METHODS: This longitudinal study included 154 pregnant women undergoing transvaginal ultrasound assessment of the cervix at a mean gestational age of 12, 16, 20, 25, and 31 weeks. On each occasion, the longitudinal and anteroposterior diameters of the cervix were measured. The rate of prematurity in the series was 1.9%, and the mean gestational age at delivery was 38.7 weeks. RESULTS: Overall, cervical length (mean 4.3 cm; 95% confidence interval 4.1-4.3) did not change significantly (P = .06), whereas the anteroposterior diameter of the cervix at its midportion shortened throughout the investigated period of gestation. Multiparous women had longer and thicker cervices than primigravidas or women with previous cesareans or first-trimester abortions. Gestational age at delivery did not correlate with cervical dimensions at any stage of pregnancy. CONCLUSIONS: The cervix undergoes a change in shape from cylindrical to conic, more marked in primigravidas than in parous women. Women who had previous cesarean deliveries had cervical characteristics similar to primigravidas; therefore, it appears that mechanical, rather than hormonal, factors have a greater effect in determining changes of cervical dimensions throughout pregnancy.

[New pharmacological approach to therapy of perimenopausal meno-metrorrhagia. Vaginal use of progesterone]. / Nuovo approccio farmacologico alla terapia delle meno-metrorragie peri-menopausali. Utilizzo del progesterone per via vaginale.

The authors evaluate the effectiveness of a therapy based on natural progesterone to be employed as a vaginal cream in the treatment of meno-metrorrhagia in peri-menopause in 40 patients who were not prepared to consider surgery as a solution for their problems. In the polycentric out-patient study this new preparation has proved to be efficacious and to induce a regression of the endometrial hyperplasia in more than 90% of patients subject to five months' treatment.

[Treatment with GnRH analogs in polycystic ovarian disease. A collaborative multicenter study. The preliminary results]. / Il trattamento con analoghi del GnRH della malattia policistica dell'ovaio. Studio policentrico collaborativo. Risultati preliminari.

The study evaluates the efficacy of tryptorelin treatment in cases of acne and hirsutism associated with polycystic ovarian (PCO) disease. This non-comparative open study in a sample population of 20 young patients who wished to have children demonstrates the reduction of the hirsutism and acne score after six months' treatment. Tryptorelin was even capable of normalizing the hematic hormonal levels examined and ovarian function following six months of treatment, as well as at an initial follow-up after three months. The authors state their intention of performing a larger trial in order to observe the real efficacy of tryptorelin in a study which includes a 12-month follow-up to assess the pregnancy rate.

[Therapy of simple endometrial hyperplasia with GnRH analogs. Evaluation of a multicentric ambulatory study. Preliminary results]. / Trattamento con GnRH analoghi della iperplasia endometriale semplice. Valutazione di uno studio policentrico ambulatoriale. Risultati preliminari.

Endometrial hyperplasia is a frequent pathology during menopause and involves the risk of malignant transformation of the lesions. In an attempt to avoid radical surgery, this study proposes the use of triptorelin which was used to treat 56 patients with histologically confirmed symptoms of endometrial hyperplasia without atypia. GnRH-analog was administered using the intramuscular route every 28 days for 6 months. Histological controls were carried out 30 days after the last injection and showed the resolution of histological symptoms, confirmed after three months.

[Fluconazole in the treatment of vaginitis caused by Candida albicans]. / II Fluconazolo nel trattamento delle vaginiti sostenute da Candida albicans.

The authors verified the local activity and tolerance of the antimycotic drug Fluconazole in 125 cases of women suffering from clinical diagnosed vulvovaginitis caused by Candida albicans. Results were positive with regard to the efficacy and safety of the treatment.

Diagnostic and therapeutic transabdominal amnioinfusion in oligohydramnios.

We report our experience with 92 antenatal amnioinfusion procedures. In order to facilitate ultrasound visualization, a diagnostic infusion was attempted at a median of 22 weeks (range 16-36) in 61 pregnancies with oligohydramnios in the absence of ruptured membranes on clinical examination. The procedure was successful in 58 (95%). Infusion (mean volume 181 mL, range 40-64) significantly increased (P less than .001) the deepest pool of amniotic fluid to a mean of 3.2 cm. Suspected fetal anomalies were then confirmed in 27 of 30 cases, whereas kidneys were clearly demonstrated in three fetuses suspected of renal agenesis. In addition, previously unsuspected anomalies were identified in five. Vaginal leakage indicating ruptured membranes occurred in 16 women. Leakage occurred in zero of 24 patients with, compared to 16 of 35 without, fetal urinary disorders (chi 2 = 15.1, P less than .001), which does not support the recent suggestion that amnioinfusion causes rather than unmasks rupture of the membranes. Membranous detachment was observed by ultrasound in 13 patients, 11 of whom leaked vaginally. Information obtained at amnioinfusion led to a change of etiologic diagnosis in eight (13% of subjects). Forty serial infusions were performed in nine women as a pilot study to prevent oligohydramnios sequelae. There were no skeletal deformities; three neonates survived, and five of the six perinatal deaths had normal lung-body weight ratios. Overall, only two of 89 infusions (2.2%) were complicated by clinical amnionitis. Our findings support a role for amnioinfusion in oligohydramnios.

The ESHRE multicentre trial on the treatment of unexplained infertility: a preliminary report. European Society of Human Reproduction and Embryology.

Nineteen European fertility centres participated in a controlled randomized trial aimed at comparing the effectiveness of five methods for the treatment of unexplained infertility. Each centre was invited to employ two of the five treatments being investigated, and the treatment allocated to individual patients was then decided by randomization. The treatments were superovulation alone, and superovulation together with one of the following procedures: intra-uterine insemination (IUI), intra-peritoneal insemination (IPI), gamete intra-Fallopian transfer (GIFT), in-vitro fertilization (IVF). All the patients admitted to the study had experienced greater than 36 months infertility prior to the start of the trial, and only patients less than 38 years of age were included in the investigation. Further, the study was confined to patients with normal Fallopian tubes, and where there was evidence of spontaneous ovulation. Yet another prerequisite for inclusion in the study was that the male partner was 'normal' as regards fertility. Due to unavoidable practical difficulties, the experimental design eventually obtained was severely unbalanced. Nevertheless, objective statistical comparisons were possible among the five treatments, using non-orthogonal analyses of variance. By the completion of the trial 444 patients had been treated in a total of 649 cycles. There was some statistical evidence that the pregnancy rate obtained from superovulation alone was inferior to that obtained by using superovulation together with one of the methods of assisted conception.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler velocimetry versus nonstress test in the antepartum monitoring of low-risk pregnancies.

One thousand singleton low-risk pregnancies were cross-sectionally studied at 36-40 weeks gestation with continuous-wave Doppler ultrasonography in order to assess its usefulness as an antepartum monitoring technique for the identification of fetuses at risk of developing an adverse outcome. Uterine artery and umbilical artery S/D values were measured and related to fetal outcome. Results were compared with those of the nonstress test. No significant differences in fetal outcome, with the exception of birth weight, were found between patients with normal and abnormal uterine S/D values. In pregnancies with abnormal umbilical S/D values, a higher incidence of cesarean section for fetal distress and lower birth weight were observed. Moreover, those newborns more frequently had complications such as low 5-minute Apgar score, requiring resuscitation and admission to the intensive care unit. When compared to nonstress test, umbilical velocimetry showed a higher efficiency in identifying fetuses at risk for adverse outcome.