The role of selectins in the first trimester pregnancy loss.

OBJECTIVE: There are no well-defined findings about reasons for first trimester abortion in some pregnancy cases. Selectins are cell adhesion proteins which are important for blastocyst implantation in the decidua. The goal of the study was to investigate the role of selectins in first trimester pregnancy loss by immunohistochemistry. STUDY DESIGN: Decidual and placental tissue samples have been obtained from the women with unwanted pregnancy as the control group (n = 40) and missed abortion (n = 40) as the study group. Immunohistochemistry technique has been used to compare P, L and E-selectin expression of the fibroblast and the decidual cells in uterine decidual stroma; and fibroblasts and mesenchymal cells in placental villous stroma. Immunostaining for P, L, E-Selectin has been evaluated semiquantitatively by HSCORE analysis. RESULTS: Decidual cells, for E and L-selectin showed stronger staining in the study group than controls, and the difference was statistically significant (p = 0.007, p = 0.007). P-selectin showed stronger staining in the control group, but the difference was not as significant as the E and L-selectins (p = 0.04). In the placenta, cytotrophoblasts and syncytiotrophoblasts showed stronger staining for P, E, L-selectins for the control group (p < 0.007, p = 0.001 and p < 0.001, respectively). CONCLUSION: Strong expression of each of the three investigated selectins in healthy pregnancy villi shows their contribution to implantation and strong placentation. There is a need for better understanding of the functions of adhesive molecules in these events to reveal unknown causes for pregnancy loss.

In vitro fertilization in normoresponder patients with endometriomas: comparison with basal simple ovarian cysts.

OBJECTIVE: To investigate whether the space-occupying effect of an endometrioma, rather than endometriosis itself, affects results in in vitro fertilization (IVF) using women with simple ovarian cysts as the control group. METHODS: 85 normoresponder patients with endometriomas of 10-50 mm who underwent IVF treatment directly without initial removal were compared with 83 normoresponder patients with simple ovarian cysts of 10-35 mm detected at the beginning of stimulation and initiated treatment without aspiration. RESULTS: Gonadotropin consumption was higher in the endometrioma group (3,013 vs. 2,451 IU; p = 0.001), although significantly fewer numbers of oocytes were retrieved (13.9 vs. 16.4; p = 0.03). However, oocyte maturation rates were similar. The transferred grade I embryos ratio was evaluated and found to be better in the cyst group (79.7 vs. 70.7%; p = 0.03). Consequently, the implantation rate was found to be significantly higher in the cyst group (28 vs. 19%; p = 0.02), although pregnancy and ongoing pregnancy rates were similar. CONCLUSION: The presence of an endometriotic cyst during the IVF cycle was demonstrated to be associated with a lower embryo quality and implantation rate, although pregnancy success was unaffected. This adverse effect is suggested to be the result of the disease itself, not the presence of a cystic mass.

A comparative study of the effect of raloxifene and gosereline on uterine leiomyoma volume changes and estrogen receptor, progesterone receptor, bcl-2 and p53 expression immunohistochemically in premenopausal women.

OBJECTIVE: To compare the mechanism of action of raloxifene and gosereline induced shrinkage of leiomyomas via estrogen receptor, progesterone receptor, bcl-2 and p53 expression immunohistochemically. STUDY DESIGN: Thirty-two premenopausal women affected by uterine leiomyomas were randomized into two equal groups. Group A was treated with gosereline (3.6 mg subcutaneous injection monthly) and group B was treated with raloxifene (60 mg daily per os) for 3 months before undergoing surgery. At entry and at the end of the treatment the leiomyoma volume was measured ultrasonografically and the volume change was calculated. Immunohistochemical detection of estrogen receptor (ER), progesterone receptor (PR), bcl-2 and p53 were performed on leiomyoma tissue samples from group A, group B and the matched-control group. H-scores for ER, PR, bcl-2 and p53 were calculated. The mean volume changes of leiomyomas and immunohistochemical H-score differences of ER, PR, bcl-2 and p53 were compared between groups. RESULTS: The leiomyoma volume decreased significantly after treatment in gosereline group from baseline of 65 cm(3) to 35 cm(3), and in raloxifene group from 68 cm(3) to 50 cm(3), p<0.05. The difference between the before and after treatment leiomyoma volumes between the two treatments was not statistically significant. H-score of ER expression was significantly lower in gosereline group compared to control group (54.4 versus 113.2, p = 0.001), whereas H-score of PR expression was significantly lower with both gosereline and raloxifene groups compared to control group (64.8 for gosereline versus 94.6 for control, 73.6 for raloxifene versus 94.6 for control, p = 0.001). The bcl-2 expression was higher in both gosereline and raloxifene groups compared to control group (173.7 for gosereline versus 94.7 for control, 179.7 for raloxifene versus 94.7 for control, p = 0.001). The p53 expression was only lower with gosereline than the control group (169.4 versus 205.6, p = 0.001), whereas there was no significant change between the raloxifene group and the control group (201.9 versus 205.6) (p>0.05). CONCLUSION: Raloxifene was as effective as gosereline in reducing leiomyoma volumes. Decreased PR expression may be a mechanism for tumor growth reduction in raloxifene treatment. In both treatment modalities, the mechanism of shrinkage of leiomyomas could not be increased apoptosis mediated by bcl-2 and p53 expression and should be investigated by further studies.

Serum oestradiol and beta-HCG measurements after day 3 or 5 embryo transfers in interpreting pregnancy outcome.

The aim of this study was to assess the clinical value of serum oestradiol concentration 8 days after embryo transfer (D8E2) and beta-human chorionic gonadotrophin (HCG-beta) concentration 12 days after embryo transfer (D12HCG-beta) in the prediction of pregnancy and the outcome of pregnancy following assisted reproduction, taking into account the day of transfer, which was either day 3 (D3) or day 5 (D5). The objective was to improve patient counselling by giving quantitative and reliable predictive information instead of non-specific uncertainties. A total of 2035 embryo transfer cycles performed between January 2003 and June 2005 were analysed retrospectively. Biochemical pregnancy, ectopic pregnancy and first-trimester abortions were classified as non-viable pregnancies; pregnancies beyond 12 weeks gestation were classified as ongoing pregnancies (OP). Significantly higher D8E2 and D12HCG-beta were obtained in D5 transfers compared with D3 transfers with regard to pregnancy and OP (P

Changed Bcl:Bax ratio in endometrium of patients with unexplained infertility.

Apoptosis has been shown to be an important regulator of endometrial function during the menstrual cycle and implantation. Recently, some possible implantation defects were identified in patients with unexplained infertility. In this study, we investigated the role of spontaneous apoptosis, which is regulated by death regulatory genes, such as Bcl-2, Bax, p53, and isoenzymes of nitric oxide synthases; eNOS and iNOS during the implantation window in women with unexplained infertility. Endometrial samples were evaluated from fertile (n=15) and unexplained-infertile women (n=15) during post-ovulatory 7th or 8th day of their menstrual cycles. Apoptotic cells were detected using the dUTP nick-end labelling assay and Bcl-2, Bax, p53, iNOS and eNOS were assessed immunohistochemically. Reduced apoptotic cells, weak immunoreactivity of p53 and strong immunoreactivity of Bcl-2 were observed in the unexplained-infertile group compared with the fertile group (p<0.001). Bax intensity was similar in both groups. While weak iNOS immunoreactivity was detected in both groups, moderately increased eNOS immunoreactivity was observed in infertile cases. Spontaneous apoptosis is reduced in the endometrium of unexplained-infertile women, and is associated with the changed Bcl-2:Bax ratio. This finding may be a contributing factor to defective implantation causing infertility in this group of patients.

Immunohistochemical detection of transforming growth factor-alpha, epidermal growth factor, and vascular endothelial growth factor expression in hyperstimulated rat ovary.

OBJECTIVE: The aim of the present study is to figure out the immunohistochemical expression of transforming growth factor-alpha (TGF-alpha), epidermal growth factor (EGF), and vascular endothelial growth factor (VEGF) in hyperstimulated rat ovaries. METHODS: Twenty Wistar-Albino adult female rats (250-300 g) were taken into the study. The animals were randomly divided into two groups, each containing 10 rats: (i) stimulation group and (ii) control group. In the stimulation group, a stimulation regimen was administered to induce follicular maturity and ovarian hyperstimulation syndrome (OHSS) at the end using a 30-IU follicle-stimulating hormone that was administered subcutaneously for 4 consecutive days, followed by a 30-IU human chorionic gonadotropin on day 5 to induce ovulation. The rats, in the control group, received 0.2 ml of 0.9% NaCl for 5 consecutive days to mimic the conditions of the study animals. At the end of the treatment period, all rats underwent ovariectomy and the sections of ovaries were stained for the TGF-alpha, EGF, and VEGF. RESULTS: The expression of TGF-alpha, EGF, and VEGF in the endothelium, the stroma, the granulosa cells, and the corpus luteum was found to be significantly higher in the stimulated group, compared to that in the control group ( p < 0.05). CONCLUSION: TGF-alpha, EGF, and VEGF are found to have increased in the hyperstimulated ovaries and this finding seems to be involved in the OHSS pathogenesis.

Fetal intra-abdominal umbilical vein dilatation associated with notching in umbilical artery.

INTRODUCTION: Dilatation of the fetal intra-abdominal umbilical vein is a rare entity. It is unclear whether prenatally diagnosed umbilical vein dilatation is associated with an increased risk of fetal anomalies or poor perinatal outcome. Umbilical artery waveform notching may be a predictor of cord abnormalities. It seems reasonable following the baby closely after the diagnosis of both conditions. CASE REPORT AND DISCUSSION: We present here a new case diagnosed by ultrasonography at 30 weeks of gestation with normal fetal outcome and discuss the clinical features and the management of these rare abnormalities.

Different anesthesiologic strategies have no effect on neonatal jaundice.

OBJECTIVE: In this prospective study, we examined the influence of either segmental epidural anesthesia with bupivocaine hydrochloride or general anesthesia with sevoflurane on serum bilirubin levels and jaundice in neonates born with caesarean section. MATERIALS AND METHODS: The patients at 38-40 weeks were included into this prospective study. General anesthesia group (sevoflurane); Group A, (n=66) and segmental epidural anesthesia group (bupivocaine hydrochloride); Group B, (n=76) underwent caesarean section under elective circumstances. Neonatal serum bilirubin levels were determined at the ages of 24 h and 5 days in 142 infants. The sexuality, weight, 5th minute APGAR scores, hematocrit levels of the neonates were recorded. The neonates who needed phototherapy were also noted. The results in Group A and Group B were compared. RESULTS: There was no significant difference on bilirubin levels between two groups and the incidence of hyperbilirubinemia did not differ statistically (p>0.05). The percent of the newborns who needed phototherapy displayed no significant differences between the deliveries by caesarean section under general or segmental epidural anesthesia. CONCLUSION: Our findings support the clinical studies which have not demonstrated an association between different anesthesiologic strategies and neonatal jaundice.

Immunolocalization of alphaV, alpha3 and beta1 integrins in the human placenta with pre-eclampsia.

Signs of pre-eclampsia are considered to be caused by maternal endothelial dysfunction due to circulating factors of placental origin. Integrins are a large family of cell surface, proteins that serve as receptors involved in cell-cell and cell-matrix interactions during placentation. Therefore, low expression of integrins or the lack of it may be encountered during pre-eclampsia. In the present study, we investigated the immunolocalisation of integrins alphaV, alpha3 and beta1 in placentas of normal and pre-eclamptic women. Thirty-two placentas from pre-eclamptic (n = 14) and normotensive (n = 18) women were used. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded tissue specimens, using anti-alphaV, anti-alpha3 and anti-beta1 antibodies and the indirect immunoperoxidase technique. A semi-quantitative grading system (HSCORE) was used to compare immunohistochemical staining intensities. Distribution patterns of alphaV, alpha3 and beta1 integrins were detected in cytotrophoblasts and Hofbauer cells in normal and pre-eclamptic placentas. Immunostaining of alphaV and beta1 integrins was slightly decreased in pre-eclamptic samples but alpha3 integrin immunostaining was similar in pre-eclamptic and normal placentas. Decreased immunostaining of integrins in the cytotrophoblasts may considered to be a structural basis for decreased placental perfusion in pre-eclampsia.

Rupture of rudimentary horn pregnancy at the 15th week of gestation: a case report.

A patient with acute abdomen at 15th week of gestation underwent an emergency laparatomy. A ruptured rudimentary horn pregnancy was diagnosed, and the rudimentary part including the fetus and the accessories was resected. The mother survived without any complications.