Leiomyoma on the septum of a septate uterus with double cervix and vaginal septum: a challenge to manage.

OBJECTIVE: To describe the first case of a leiomyoma localized in the septum of a septate uterus that had cervical duplication and a longitudinal vaginal septum. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 43-year-old patient with primary infertility and complaint of menorrhagia. INTERVENTION(S): Laparotomy, adhesiolysis, myomectomy, and resection of the vaginal septum in the first operation. Hysteroscopic resection of the complete uterine septum in the second operation. MAIN OUTCOME MEASURE(S): Magnetic resonance imaging findings and two-step repair of the anomaly. Cervical length at second trimester. RESULT(S): Restoration of normal anatomy was achieved after correct diagnosis and a two-step operation procedure. A normal cervical length was measured at 26 weeks of gestation. CONCLUSION(S): Large leiomyoma at rare localizations in the presence of uterine anomalies is a diagnostic challenge, but with available diagnostic technology and appropriate operations, successful results can be obtained.

Color Doppler sonographic analysis of uterine and ovarian artery blood flow in women with polycystic ovary syndrome.

PURPOSE: To study the blood flow patterns of utero-ovarian circulation in polycystic ovary syndrome (PCOS) and to assess their relationship with clinical, metabolic, and hormonal data. METHODS: Forty-three women with PCOS and 43 age-matched healthy controls underwent Doppler examination of the utero-ovarian circulation in the follicular phase. Demographic, hormonal, and metabolic parameters were determined. Student's t-test, chi(2)-test, and Spearman correlation test were used for statistical analysis. RESULTS: The ovarian artery pulsatility index (PI), resistance index (RI), and SD ratios were significantly lower in PCOS than in controls on the right side (p < 0.001, p = 0.02, p = 0.001, respectively) as well as on the left side (p < 0.001, p < 0.001, p < 0.001, respectively). The uterine artery systolic/diastolic (S/D) ratio was higher on both sides (p = 0.01) and the PI was higher on the left side (p = 0.02) in PCOS than in controls. The right uterine artery PI was positively correlated with luteinizing hormone and hemoglobin (r = 0.417, p = 0.043; r = 0.427, p = 0.033, respectively), the right uterine artery S/D was positively correlated with body mass index (r = 0.479, p = 0.015), and the left uterine artery PI was positively correlated with insulin (r = 0.458, p = 0.021). CONCLUSION: Doppler sonography of the utero-ovarian circulation may contribute to the evaluation of PCOS patients and a better understanding of the pathophysiology of this syndrome.

Evaluation of metabolic syndrome frequency and premature carotid atherosclerosis in young women with polycystic ovary syndrome.

BACKGROUND: The aim of this study was to evaluate metabolic syndrome frequency, cardiovascular risk profile and premature carotid artery atherosclerosis in patients with polycystic ovary syndrome (PCOS) especially during early adulthood. METHODS: A case-control study was conducted on 43 young women (18-22 years of age) with PCOS and 43 age-matched volunteer controls. Anthropometrical measurements, hormone levels, lipid and glucose profile were obtained from all subjects. Two different criteria were used to assess metabolic syndrome (MS) frequency. Common carotid artery intima-media thickness (IMT) was measured and stepwise multiple linear regression analysis was used to identify the independent cardiovascular risk factors that predict IMT. RESULTS: MS was diagnosed in 11.6% (n = 5) of women with PCOS compared to no cases in the control group (P = 0.02). The mean IMT was significantly higher in PCOS subjects (0.746 +/- 0.106 mm) compared to controls (0.608 +/- 0.105 mm, P < 0.001). Among many cardiovascular risk factors evaluated, the diagnosis of PCOS, increased body mass index and decreased sex hormone-binding globulin were significant independent predictors of increased IMT. CONCLUSIONS: These findings indicate that adolescence may be a more appropriate time to intervene for PCOS patients, as many cardiovascular risks are already present during early adulthood. As far as IMT is concerned, mechanisms other than hyperandrogenaemia and obesity might be operating as causative factors.