Colour Doppler analysis of ovarian and uterine arteries in women with hypoestrogenic amenorrhoea.

BACKGROUND: This is a clinically-controlled study designed to investigate uterine and ovarian blood flow in patients with hypoestrogenic amenorrhoea. METHODS: Twelve women with hypoestrogenic amenorrhoea and 13 eumenorrhoeic subjects (controls) were enrolled. Colour and pulsed Doppler was used to visualize the uterine and ovarian arteries and the blood vessels within the ovarian stroma in both groups. Four blood flow indices were calculated: the pulsatility index, the resistance index, the peak systolic velocity and the end-diastolic velocity. RESULTS: Peak systolic velocity underwent the most significant change in amenorrhoeic patients, being significantly lower in comparison with that of controls, both in the uterine (P = 0.0009) and ovarian (P = 0.001) arteries. Compared with controls, the end-diastolic velocity of the ovarian artery was significantly lower (P = 0.039) in amenorrhoeic patients, and was also lower in the uterine artery (though not statistically significantly so). A reduction in blood flow was also evident in the ovarian stroma in amenorrhoeic patients. CONCLUSIONS: The significant reduction in blood flow observed in hypoestrogenic amenorrhoea suggests that estrogens play an important role in regulating both uterine and ovarian blood flow.

Assessment of uterine artery blood flow in normal first-trimester pregnancies and in those complicated by uterine bleeding.

OBJECTIVE: To compare uterine artery blood flow in normal first-trimester pregnancies with those complicated by uterine bleeding. METHODS: Uterine artery blood flow was investigated by transvaginal color Doppler in 46 pregnant women affected by uterine bleeding and in a control group of 35 women with normal intrauterine pregnancy. Gestational age ranged from the 6th to the 12th week. Three blood flow values were calculated, the pulsatility index, the resistance index and the peak systolic velocity. Results were compared between the two groups. RESULTS: Of the 46 patients affected by uterine bleeding, 18 had an incomplete miscarriage, eight had a blighted ovum, five had a missed miscarriage and 15 continued their pregnancy until term and delivered liveborn infants. No significant differences were found in any of the three vascular indices between the normal and the pathological groups of patients. Uterine artery pulsatility and resistance indices decreased with gestational age in both normal and abnormal pregnancies but this change was not statistically significant. The peak systolic velocity significantly increased with gestational age in the control group but not in the pathological group. In patients with a retroplacental hematoma, uterine vascular resistance appeared higher than in those without a hematoma, while the peak systolic velocity showed no difference between the two groups. CONCLUSION: Doppler analysis of the uterine artery blood flow is unlikely to have a clinical role in the management of early pregnancies complicated by uterine bleeding.

Obstetric complications in patients with depression--a population-based case-control study.

BACKGROUND: To examine whether sufferers of affective disorders are more likely to be subject to obstetric complications than normal healthy people. METHOD: Data based on prospectively recorded birth case-notes for patients with a diagnosis of depression (or related disorders) with early onset were compared to those of normal healthy controls, individually matched by gender, time and parity of birth, maternal age and marital status. RESULTS: Forty-one case-controls pairs born between 1964 and 1978 were compared. No differences between cases and controls in gestational age or birthweight were significant, though depressive patients on average weighed 200 g less than controls at birth. Patients were more likely than controls to be small for their gestational age (22 vs. 1: chi(2)=4.34, P=0.03). They were significantly more likely than controls to have suffered at least one obstetric complication: 35 (85%) vs. 25 (60%), chi(2)=5.03, P=0.02; or more than one (two on average, as opposed to one on average among controls). No obstetric complication was seen significantly more among cases than controls, apart from bleeding during gestation, which was observed for four cases and no controls. The prevalence of complications with a clear brain damaging potential did not differ significantly between cases and controls: 11 (26%) vs. 8 (19%). CONCLUSIONS: A developmental deficit, as indicated by lower birthweight and gestational age, may contribute to the risk of depressive breakdowns and affective disorders in later life. Severe, brain damaging obstetric complications are unlikely to be a significant risk factor for affective disorders, though some early onset cases may be accounted for by prenatal brain lesions. LIMITATIONS: Sample size limits statistical power for isolation of a rare, single risk factor.

Embryo development in vitro of cat oocytes cryopreserved at different maturation stages.

The purpose of this study was to evaluate the ability of cat oocytes, at different stages of maturation, to survive after cryopreservation and to assess their subsequent development following IVM and IVF. In the initial toxicity trial, immature oocytes were exposed to different concentrations of DMSO and ethylene glycol (EG). Resumption of meiosis and metaphase II were evaluated after removal of the cryoprotectant and IVM. The highest rates of resumption of meiosis (51.4%) were achieved after exposure to 1.5 mol l(-1) of cryoprotectants, and no difference was observed with control oocytes. Metaphase II was obtained in 25.7% (P<0.01) and 22.9% (P<0.005) of oocytes exposed to 1.5 mol l(-1) of DMSO and ethylene glycol, although at lower rates than in control oocytes (54.4%). On the basis of this finding, 1.5 mol l(-1) of cryoprotectant was chosen for freezing cat oocytes at the germinal vesicle stage (immature) or at metaphase II stage (mature). Post-thaw viability was assessed by the evaluation of the embryo development in vitro. After fertilization, mature oocytes frozen in ethylene glycol cleaved in better proportions (38.7%) than immature oocytes (6.8%, P<0.001), and no differences were observed in the cleavage rate of oocytes frozen at different maturation stages with DMSO (immature 12.8%; mature 14.1%). Embryonic development beyond the 8-cell stage was obtained only when mature oocytes were frozen with ethylene glycol (11.3%). This study suggests that cryopreserved cat oocytes can be fertilized successfully and that their development in vitro is enhanced when mature oocytes are frozen with ethylene glycol. The stage of maturation may be a key element in improving cat oocyte cryopreservation.

Effects of slow and ultrarapid freezing on morphology and resumption of meiosis in immature cat oocytes.

This study examined the ability of immature cat oocytes to survive after cryopreservation by evaluating their subsequent development following maturation in vitro. The effect of slow and ultrarapid freezing using one of two cryoprotectants dimethylsulphoxide (DMSO) or 1,2-propanediol (PROH) at different concentrations (1.5 or 3.0 mol-1) and the slow freezing with the cryoprotectant ethylene glycol (EG 1.5 mol l-1 and 3.0 mol l-1) were tested. Morphology, resumption of meiosis and metaphase II rates of oocytes were recorded after thawing. Freshly collected oocytes were used as controls. Results indicate that immature cat oocytes can survive, resume meiosis and achieve metaphase II in vitro after freezing. The highest rates of resumption of meiosis and metaphase II were achieved with slow freezing and 1.5 mol DMSO or EG l-1 (DMSO: 47.4%, 18/38 and 23.7%, 9/38 and EG: 52%, 13/25 and 20%, 5/25, respectively). The ultrarapid procedure did not result in resumption of meiosis in vitro, despite intact morphology of the oocytes after thawing. These results suggest that morphology of oocytes after freezing and thawing has no predictive value for their ability to resume meiosis.

A rare case of IUD tubal migration. Case report.

The Authors describe a rare case of IUD tubal migration. The uterine device had been inserted twelve years before. A hysteroscopical removal of the IUD was tried unsuccessfully, because it was impossible to locate it either in the uterine cavity or at the fallopian tube orifice level. The patient underwent a minilaparotomy and the IUD was found out at the peritubal level. An ecographic control of all intrauterine devices insertions is recommended.

Giant cell arteritis of fallopian tube.

One case of giant cells arteritis involving tubaric arteries in a postmenopausal woman is described. The patient was 59 years old and presented with asthenia, anemia, fever, weight loss, an abdominal palpable mass and elevated erythrocyte sedimentation rate. Exploratory laparotomy revealed a large ovarian cyst of 14 cm in diameter. Extensive giant cell arteritis, Horton's type, of the small-sizes arteries was found unexpectedly in the fallopian tube of the patient who had had a prior ovariectomy. Giant cell arteritis of the female genital tract is a rare finding in elderly women and may occur as an isolated finding or as part of generalised arteritis.

The significance of the relationship between serum levels of cobalamin and MCHC during pregnancy.

Cobalamin concentration and mean corpuscular haemoglobin concentration (MCHC) were found to have highly significant inverse correlation with the weeks of pregnancy (respectively -.278 P < .0001 and .342 P < .00001) in 205 pregnant women. Among all haematometric parameters cobalamin concentrations during pregnancy only correlates with MCHC (P < .01). This datum seems to indicate an influence of B12 on erythropoiesis which adequate the concentration of haemoglobin to circulatory modifications of pregnant women.

Iron balance in pregnancy in relation to anemia.

Blood levels of iron, transferrin and ferritin varied in the course of pregnancy (6th to 42nd week) in 136 women. Analysis of variance showed that the factor "weeks of pregnancy" (< or = 27 or > 27 weeks) was correlated differently with the variables "ferritin" and "iron" according to the presence or absence of anemia (Hb < or = or > or = 11 g/dl). In anemic women the correlation was significant (F-ratio = 5.90; P = 0.018) for iron (which decreased from initial low level until term) but not ferritin, whereas in non-anemic women the correlation was significant (F-ratio = 13.306; P = 0.0006) for ferritin (which decreased to less than 20 micrograms/ml around the 34th week) but not iron. In both anemic and non anemic subjects, transferrin levels increased with weeks of pregnancy. It is concluded that towards the end of pregnancy, some decrease in ferritin (> or = 15 micrograms/ml) is physiological, and in the absence of anemia (Hb > 11 g/dl) iron supplements are not necessary.

Conservative surgery in vulvar-vaginal neoplasias and fertility. 3 clinical cases.

In this article we present three clinical cases of patients affected by vulvar neoplasm. Since the patients were very young when the disease was diagnosed, we decided for a conservative treatment. All patients underwent a surgical non-mutilant therapy which guaranteed a surgical radicality and, at the same time allowed them a normal reproductive life. Later all patients conceived and their pregnancies developed physiologically till the end. One patient died 23 years later; the two other are still alive and disease-free.