Oxigenación por membrana extracorpórea veno-arterial en un paciente con embolia pulmonar de alto riesgo / Oxygenation by extracorporeal veno-arterial membrane in a patient with high-risk pulmonary embolism

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Prospective evaluation of the impact of intermenstrual bleeding on natural fertility.

OBJECTIVE: To evaluate the impact of an episode of intermenstrual bleeding on the probability of conception in a menstrual cycle (fecundability). DESIGN: Prospective, time-to-pregnancy cohort study. SETTING: Community-based cohort. PATIENT(S): Women trying to conceive, ages 30 to 44 years, without known infertility. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Current cycle and subsequent cycle fecundability. RESULT(S): A total of 549 women provided 1,552 complete cycles for analysis. Intermenstrual and luteal bleeding were reported in 36% and 34% of cycles, respectively. Ninety-three percent of all intermenstrual bleeding was luteal. Cycles in which women had intermenstrual bleeding or luteal bleeding were statistically significantly less likely to result in conception (fecundability ratio [FR] 0.23; 95% confidence interval [CI], 0.16-0.34; and FR 0.22; 95% CI, 0.14-0.33). Women with an episode of intermenstrual and luteal bleeding had a statistically significant increase in the probability of pregnancy in the subsequent cycle (FR 1.61; 95% CI, 1.15-2.25; and FR 2.01; 95% CI, 1.52-2.87, respectively). CONCLUSION(S): Intermenstrual bleeding statistically significantly decreases the odds of conceiving in that cycle but does not appear to negatively impact a woman's immediate future reproductive potential. CLINICAL TRIAL REGISTRATION NUMBER: NCT01028365.

Hallazgos histeroscópicos en pacientes posmenopáusicas en el Complexo Hospitalario Universitario de Ourense / Hysteroscopic findings in postmenopausal patients in the University Hospital Complex of Ourense (Spain)

Objetivos: Se describen los hallazgos histeroscópicos en las pacientes posmenopáusicas. Se analizan las características epidemiológicas de pacientes con adenocarcinoma de endometrio. Material y métodos: Estudio retrospectivo descriptivo de las histeroscopias diagnósticas realizadas en nuestro servicio a 451 pacientes posmenopáusicas entre el 1 de enero de 2008 y el 30 de junio de 2012 en el Complexo Hospitalario Universitario de Ourense (CHUO). Resultados: Edad media de 64,8 ± 8,9 años, la mayoría multíparas (82,7%) y con enfermedad concomitante más frecuente la hipertensión arterial (37,3%), dislipidemia (20%) y obesidad (12,6%). El 45,7% habían presentado sangrado genital. La indicación más frecuente fue la sospecha ecográfica de pólipo endometrial. Presentaron dolor intenso durante la técnica el 14,4% de las pacientes. La concordancia entre la sospecha ecográfica de enfermedad intracavitaria e histeroscopia diagnóstica fue del 66,3% para los pólipos endometriales. La concordancia entre histeroscopia e histología para el carcinoma endometrial fue del 87,5%. En las situaciones en las que se indicó la prueba por endometrio engrosado mayor a 5 mm se encontró enfermedad endometrial e intracavitaria en el 66,7% de los casos. Se diagnosticó un 5,3% de pacientes con adenocarcinoma de endometrio, con sangrado posmenopáusico, un 62,5%. Conclusiones: No existen diferencias en relación con los hallazgos y diagnósticos histológicos entre mujeres sintomáticas y asintomáticas, aunque la enfermedad maligna se presenta con mayor frecuencia en pacientes con sangrado. Cabe destacar la buena concordancia entre la histeroscopia y el diagnóstico histológico en el carcinoma de endometrio, pólipos endometriales y endometrios normales

Objectives: To describe hysteroscopic findings in postmenopausal patients and to analyze epidemiologic characteristics in patients with endometrial adenocarcinoma. Materials and methods: A retrospective descriptive study was carried out in the 451 postmenopausal women who underwent a diagnostic hysteroscopy in our unit between the 1st January 2008 and 30th June 2012. Results: The mean age was 64.8 ± 8.9 years, 82.7% of the women were multiparous, and the most frequent concomitant diseases were hypertension (37.3%), dyslipidemia (20%) and obesity (12.6%). A total of 45.7% of the women reported abnormal uterine bleeding. The most frequent indication for hysteroscopy was sonographic detection of endometrial polyps. Intense pain during the procedure was reported by 14.4% of the patients. The correlation between ultrasound and hysteroscopy was 66.3% for polyps and the correlation between hysteroscopic and histopathologic diagnosis was 87.5% for endometrial carcinoma. Endometrial and intracavitary disease was detected in 66.7% of the patients with endometrial thickness > 5 mm on ultrasound. Endometrial carcinoma was diagnosed in 5.3% of the patients; of these, 62.5% reported abnormal uterine bleeding. Conclusions: There were no differences between hysteroscopic findings and histologic results in symptomatic and asymptomatic women. Malignant disease was more frequent in patients with abnormal uterine bleeding. There was a good correlation between hysteroscopic visual inspection and pathologic diagnosis in endometrial carcinoma, polyps and normal endometrium

Comparison on serum biomarkers for anovulatory and ovulatory dysfunctional uterine bleeding in Lizu females.

OBJECTIVE: To screen, identify, and compare the serum biomarkers between anovulatory dysfunctional uterine bleeding (ADUB) and ovulatory dysfunctional uterine bleeding (ODUB) in Lizu females. METHODS: The subjects included 128 ADUB patients, 63 ODUB patients, and 93 controls. The serum and supernate of the subjects' mense were collected and stored at -80 °C until use. Differential proteins in the sera of three groups were screened using surface-enhanced laser desorption ionization time-of-flight mass spectrometry. The screened proteins were then identified by tricine-SDS-PAGE gel and spectrometry. Protein expression levels in the menses of ADUB, ODUB, and control subjects were determined using ELISA, RT-PCR, and Western blotting. SPSS 14.1 was used for statistical analysis and chart drawing (α = 0.05). RESULTS: Three differential protein peaks with peak values of 11.80, 13.59, and 14.68 km/z were screened and identified as serum amyploid protein A (SAA), vascular endothelial growth factor, and vitamin K epoxide reductase, respectively. The SAA was highly expressed in the menses of ADUB and ODUB patients but poorly expressed in the controls. The vascular endothelial growth factor was highly expressed in the menses of ODUB and controls but poorly expressed in ADUB patients. Meanwhile, the vitamin K epoxide reductase was highly expressed in the menses of ADUB and control subjects but poorly expressed in ODUB patients. CONCLUSIONS: The SAA is the common serum biomarker of ADUB and ODUB. ADUB may be related to angiogenesis impairment, whereas ODUB may be associated with blood coagulation disruption.

Identification of genetic defects underlying FVII deficiency in 10 patients belonging to eight unrelated families of the North provinces from Tunisia.

Inherited factor VII (FVII) deficiency is a rare disorder characterized by a bleeding phenotype varying from mild to severe. To date, more than 200 mutations have been described along the F7 gene encoding for FVII. The aim of this study was the identification of genetic defects underlying FVII deficiency in 10 patients belonging to eight unrelated families of the North provinces from Tunisia. Mutation detection was performed by sequencing the whole F7 gene coding region, exon-intron boundaries and about 400 bp of the promoter region. We identified 5 mutations in five unrelated families; the novel p.F328Y mutation and the reported mutations: p.R304Q, p.M298I, IVS1aG > A and p.G-39G. For the remaining 5 patients we didn't identified any mutations using PCR/Sequencing protocol. In conclusion, this study represents the first comprehensive molecular series of FVII deficiency affected patients in Tunisia from the North. We will try in the future to continue the molecular study for Tunisian patients from Center and South provinces in order to have a complete idea about the FVII deficiency mutational profile in our country. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1288044089753085.

Prevalence of hyperprolactinemia in adolescents and young women with menstruation-related problems.

OBJECTIVE: The aim of this study was to evaluate the prevalence of hyperprolactinemia in adolescents and young women with menstrual problems. STUDY DESIGN: This study included 1704 young women with menstruation-related problems. The patients were classified into group I (age, 11-20 years) or group II (age, 21-30 years); the prevalence of hyperprolactinemia was analyzed according to age and categories of menstruation-related problems. RESULTS: For primary amenorrhea and oligomenorrhea, the prevalence of hyperprolactinemia was low in both groups. However, hyperprolactinemia was a relatively common cause of secondary amenorrhea (5.5% for group I and 13.8% for group II, respectively); it was more frequent in group II (P = .001); the prevalence of prolactinoma was also higher in group II (P = .015). For abnormal uterine bleeding, hyperprolactinemia was more common in group II (2.6% for group I and 9.4% for group II; P < .001), but causes were similar. CONCLUSION: Hyperprolactinemia is not rare in young women with menstruation-related problems; its prevalence varies according to age and manifestations.

[Screening and identification of serum biomarker of anovulatory dysfunctional uterine bleeding and its expression in the menses].

OBJECTIVE: To screen and identify the serum biomarker of anovulatory dysfunctional uterine bleeding (ADUB), to determine the expression of biomarker protein in menses of ADUB patients, and to investigate the relation between ADUB and the biomarker proteins. METHODS: Subjects included 128 ADUB patients and 93 age-matched controls(normal women). Their serum and supernatant of mense were collected and stored for use at -80 degree. The differential proteins in the serum of the 2 groups were detected by CM10 and analyzed by Biomarker Wizard 3.2 software. Then, the differential proteins were identified by Tricine-SDS-PAGE gel separation, spectrometry identification, and immunoprecipitation. The expression of the protein identified above in the menses was tested by ELISA, RT-PCR, and Western blotting. SPSS 14.1 was applied for statistical analysis and chart drawing. RESULTS: Five differential protein peaks were screened and their peak values were 11.80, 13.59, 13.79, 13.85, and 14.20 km/z, respectively. The intensity of protein peak (11.80 km/z) which was identified as serum amyploid protein A (SAA) of ADUB was significantly higher than that of the controls (P<0.05). While the intensity of protein peak (13.59 km/z ) which was identified as vascular endothelial growth factor (VEGF) of ADUB was obviously lower than that of the controls (P<0.05). The intensity of protein peak 13.08, 13.85, and 14.20 was not different between the cases and controls. SAA expressed highly in the menses of ADUB but low in that of the controls. Conversely, VEGF expressed highly in the menses of the control but low in that of the ADUB. CONCLUSION: Two biomarkers which might be related with ADUB have been correctly screened and identified as SAA and VEGF. It needs further study whether the increased expression of SAA and reduced expression of VEGF are the cause or result of ADUB.

Screening for coagulation disorders in adolescents with abnormal uterine bleeding.

STUDY OBJECTIVE: To determine if screening for coagulation disorders was routinely performed during the evaluation of adolescents with abnormal uterine bleeding. DESIGN: A retrospective chart review. Data were analyzed using the chi-square test. P < 0.05 was considered significant. SETTING: Outpatient clinics of an academic center. PARTICIPANTS: Eligible charts of patients age eighteen years and under with abnormal uterine bleeding who were evaluated either by pediatric gynecologists, gynecologists, or pediatricians. INTERVENTIONS: A chart review. MAIN OUTCOME MEASURES: Data on provider type, documented patient history and laboratory tests ordered. RESULTS: In our review, 43% (n= 36) of patients were evaluated by gynecologists, 38% (n=32) by pediatricians and 19% (n=16) by pediatric gynecologists. The mean age of patients whose charts were reviewed was 15 years. Overall 36.6% (n=30) of providers indicated that they screened for a bleeding disorder by documenting at least one screening question in the patient's history. There was a significant difference among providers with 68.8% (n=11) of pediatric gynecologists documenting at least one screening question, compared to 31.4% (n=11) of gynecologists and 25.8% (n=8) of pediatricians (P < 0.05). Overall 14.6% (n=12) of subjects were screened for a coagulation disorder with laboratory testing. CONCLUSIONS: The majority of adolescents with abnormal uterine bleeding were not screened for bleeding disorders. The frequency of evaluation for blood dyscrasias varied by specialty.

[Menometrorrhagia: to whom, why, on which criteria to propose a hormonal exploration?]. / Ménométrorragies : à qui, pourquoi, sur quels critères proposer une exploration hormonale ?

The hormonal exploration of menometrorrhagia concerns only the patients throughout their reproductive life, it is not indicated outside this period. In first intention at the woman in age to procreate, will be realized a determination of hCG, an inescapable determination to eliminate a pregnancy and a measure of serum TSH in the case of personal or family history for the screening of subclinical hypothyroidism. Further investigations can be carried out in second-based signs of appeal under the differential diagnosis of polycystic ovary syndrome (PCOS), as a measure serum prolactin, 17-hydroxyprogesterone and total testosterone and not bound to its binding protein the SHBG.

Histopathologic findings in women with postmenopausal bleeding: implication for endometrial thickness and circulating levels of sex steroid hormones.

OBJECTIVE: The aim of this study is to compare the relationship between estrone (E1), estradiol (E2), androgens, and prolactin blood levels on the one hand, and endometrial thickness and related histopathologic results on the other, in postmenopausal women admitted with uterine bleeding. METHODS: The study was conducted in Gazi University School of Medicine, Obstetrics and Gynecology Clinic with a total of 128 patients. The study group consisted of 64 postmenopausal patients admitted with uterine bleeding, whereas the control group consisted of 64 healthy postmenopausal women. Vaginal sonography was performed to evaluate the endometrial thicknesses of the patients. Serum levels of free testosterone, androstenedione and estrone (E1) were determined by radioimmunoassay while serum estradiol (E2), prolactin, and dehydroepiandrosterone sulfate (DHEA-S) levels were evaluated by chemiluminescent method. RESULTS: The median age, duration of menopause, menopausal age and gravidity, and parity did not differ between women with postmenopausal bleeding and the control group (P > 0.05). However, DHEA-S level was lower (P < 0.05) and endometrial thickness was greater in the study group than the control group (P < 0.05). Furthermore, the study identified that median endometrial thickness of the patients in atrophic endometrium group was less than the endometrial hyperplasia and endometrium carcinoma group (P < 0.05). CONCLUSION: In the current study, all these hormones seemed to be indifferent between groups of endometrial cancer and other pathological results. Based on our results regarding the safe margin of endometrial thickness in women with postmenopausal bleeding, it seems justifiable to refrain from curettage in patients with an endometrium of < or =4 mm.

Dysfunctional uterine bleeding (DUB).

Cyclic or irregular uterine bleeding is common in perimenarchal and perimenopausal women with or without endometrial hyperplasia. The disturbance often requires surgical treatment because of its negative effects on both blood loss and abnormal endometrial growth including the development of endometrial cancer. The endometrium is often overstimulated during the perimenopausal period when estrogen/progesterone production is unbalanced. A therapeutical approach with gonadotropin-releasing hormone agonist (GnRHa) was proposed in a depot formulation (Zoladex) that induces a sustained and reversible ovarian suppression. To avoid the risk of osteoporosis and to obtain adequate endometrial proliferation and differentiation during ovarian suppression, transdermal 17-beta-estradiol and oral progestin were administered. Results of 20 cases versus 20 controls showed a reduction of metrorrhagia, a normalization of hemoglobin plasma concentration, and an adequate proliferation and secretory differentiation of the endometrium of patients with abnormal endometrial growth. Abnormal uterine bleeding is mainly due to uterine fibrosis and an inadequate estrogen and/or progesterone production or to a disordered estrogen transport from blood into the endometrium. In premenopausal women, endometrial hyperplasia may be part of a continuum that is ultimately manifested in the histological and biological pattern of endometrial carcinoma. The regression of endometrial hyperplasia obtained by using the therapeutic regimen mentioned above represents a preventive measure for endometrial cancer. Finally the normalization of blood loss offers a good medical alternative to surgery for patients with DUB.

Use of transvaginal ultrasound in diagnosing the etiology of menometrorrhagia.

Forty-five women with a chief complaint of abnormal vaginal bleeding from a few days' duration (spotting) to three to six months of bleeding (average, 4.5 months) were evaluated using a standard clinical approach followed by transvaginal ultrasound (US). Serum estradiol (E2), progesterone and/or endometrial biopsy was used to further clarify the etiology of the bleeding and confirm the clinical or ultrasound diagnosis. Anatomic findings were present in 31% of patients by US examination as compared to only 9% by clinical evaluation. An additional 9% of patients had polycystic ovary disease. Of the 16% of study patients on oral contraceptives with a clinical diagnosis of breakthrough bleeding, 33% had anatomic findings associated with the bleeding on US. The ultrasound image of the endometrium predicted the endometrial biopsy findings in all three patients with postmenopausal bleeding. In the remaining patients with a diagnosis of dysfunctional uterine bleeding (DUB) (a diagnosis usually made clinically by excluding other etiologies), US was helpful in excluding many patients with anatomic findings not detected by physical examination and in evaluating the endometrium, helping differentiate anovulatory from ovulatory DUB. US was helpful in predicting the hormonal and histologic endometrial status of the patients. Patients with more severe and prolonged DUB had low serum E2 with US findings of a single-line endometrium (consistent with low serum E2 and anovulation). US can be a valuable aid in evaluating women presenting with a complaint of abnormal vaginal bleeding by demonstrating anatomic findings frequently not discernible on pelvic examination, such as small cysts and leiomyomas and even endometrial carcinoma, and in evaluating the endometrium in terms of its thickness and, indirectly, the endometrial histology and the ovulatory and hormonal status of the patient. US can also be of value in confirming some diagnoses that are generally made clinically by exclusion, such as breakthrough bleeding from oral contraceptive use and DUB.

[Iron deficiency dyserythropoiesis in patients with chronic gastrointestinal and gynecologic hemorrhages. Study of 39 cases]. / Diseritropoyesis ferropénica en pacientes con hemorragias crónicas gastrointestinales y ginecológicas. Estudio de 39 casos.

A defect of haemoglobin synthesis is the classically recognized mechanism affecting the erythron functionalism in chronic iron deficiency. The poor erythroblastic bone-marrow response, plus a number of dyserythropoietic nuclear features, have led to think of an impairment of the cell cycle of erythroblasts in iron-lack anaemia. The aim of the present work was to study such hypothesis, not proven so far. Ten subjects with normal haemopoiesis and 39 patients with iron-lack anaemia of different aetiologies (namely, 19 with digestive tract bleeding, 16 with gynaecological bleeding, and 4 with haemorrhages on other locations) were included in a previously reported protocol. The scheme of such protocol consisted of: 1) bone-marrow erythroblast quantification; 2) analysis of their maturation gradient; 3) erythroblast mitotic index; 4) measure of the mitotic time in bone-marrow culture; 5) tritiated-thymidine incorporation to short-term bone-marrow culture and quantification of the erythroblastic labelling index. To these were added the degree of nuclear dyserythropoiesis according to Hill and Lewis, and the reticulocyte production index. The following mean values were found in the control group: erythroblasts, 25.5 (+/- 3.63) %; E1-E4, 47.66 (+/- 3.09) %; IDN, 0.67 (+/- 0.27); MI, 2.82 (+/- 0.66) %; MT, 1.05 (+/- 0.15 hr); LI, 34.88 (+/- 5.82) %. The mean values found in iron-lack anaemias were as follows: erythroblasts 39.42 (+/- 9.1) %; E1-E4, 42.25 (+/- 4.11) %; IDN, 7.77 (+/- 4.69); MT, 1.81 (+/- 0.95) hr; LI, 13.08 (+/- 6.51) %. The statistical analysis (Student's t) showed highly significant differences (p less than 0.001) in the increased IDN and decreased MI and LI in iron deficiency patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[The course of hypoplastic anemia in women with uterine hemorrhage]. / Techenie gipoplasticheskoi anemii u zhenshchin, stradaiushchikh matochnymi krovotecheniiami.

The clinical course of hypoplastic anemia (HA) has been assessed in 21 patients with uterine bleedings. The disease was associated with severe onset and progress, profound pancytopenia and myelodepression or even critical states. Superimposed infectious inflammatory and other diseases aggravated HA by promoting hemorrhagic events, especially uterine bleedings. An initial treatment using packed erythrocyte transfusions and glucocorticoid hormones reversed anemia and hemorrhages in 11 of 21 patients with HA. Splenectomy was performed in 8 and ovariectomy in 1 of 11 patients whose blood and bone marrow tests improved after the treatment. The other 12 patients were maintained on transfusion and drug regimens. The efficacy of splenectomy and other interventions for HA in women with uterine bleedings depends on an response to received treatments.

Sequential use of norethisterone and natural progesterone in pre-menopausal bleeding disorders.

Sequential treatment with norethisterone (NET) or natural micronized progesterone (NMP) was administered randomly to 80 consecutive patients attending our clinic because of cycle disorders. The endometrial morphology indicated a need for progestogen therapy in all cases and the endometrium was hyperplastic in half of the women before therapy. Hyperplastic changes disappeared during the first three cycles of treatment with both NET and NMP, the duration of treatment being 6 months. However, the carry-over effect of both progestogens was short: three months after treatment was discontinued a proliferative or hyperplastic endometrial pattern recurred in 24% and 10% of cases, respectively. Whereas NET decreased oestradiol, follicle-stimulating hormone, luteinizing hormone and sex-hormone-binding globulin levels (P less than 0.001) no changes were seen during NMP treatment. High-density-lipoprotein cholesterol and triglyceride levels were also lowered by NET (P less than 0.001-0.02) and there was a slight decrease in phospholipids. NMP treatment induced no changes in serum lipid values and thus offers an alternative form of therapy in premenopausal bleeding disorders.

[Metabolism of fibrinogen]. / Issledovanie metabolizma fibrinogena.

Fibrinogen metabolism was studied with the use of coagulation and enzyme immunoassay techniques for measuring its concentrations and the levels of fibrinogen (fibrin) degradation products and of monomer fibrin soluble complexes in adults and children in health and disease. The detected age-associated and nosologic changes in fibrinogen and its metabolites' concentrations are discussed, as is the practical value of the methods employed.

[Indicators of lipid metabolism and aminotransferase activity in girls with dysfunctional uterine hemorrhage]. / Pokazateli lipidnogo obmena i aktivnost' aminotransferaz u devushek, stradaiushchikh disfunktsional'nymi matochnymi krovotecheniiami.

In a study of 42 girls, aged 12 to 15 years, including 27 patients with dysfunctional uterine bleedings (DUB) and 15 normal controls, the levels of glucose, total lipids, beta-lipoproteins, total cholesterol, as well as beta-lipoprotein, triglycerides, nonesterified fatty acid (NEFA) cholesterol and aminotransferrase activity were compared. NEFA levels were found to be increased fivefold over the normal values in DUB patients.

Prothrombin Gainesville. A dysprothrombinemia in a pair of identical twins.

A pair of identical twins was evaluated for menometrorrhagia and mild post-operative bleeding. Each had a slightly prolonged partial thromboplastin time and prothrombin time. Full hemostatic evaluation was normal, except that plasma prothrombin activity was 23% and 25% of normal with a Russell's viper venom assay. Each twin had 70% of normal plasma prothrombin antigen. Prothrombin kinetic data were obtained before and during hysterectomy. In these twins, infused prothrombin (Konyne) was found to have a volume of distribution of approximately one and one-half times the plasma volume and a half-life of 34 hours. The previously reported dysprothrombins are briefly reviewed. Prothrombin Gainesville is the twelfth such disorder reported.