Prevalence of sexual dysfunction among postmenopausal women with and without metabolic syndrome.

INTRODUCTION: The metabolic syndrome (MetS) is a multifactorial disease characterized by the co-occurrence of impaired glucose tolerance/diabetes, central obesity, high levels of triglycerides, low levels of high-density lipoprotein, and hypertension. Its prevalence is higher in menopausal women. We, and others, have recently shown that female sexual dysfunction (FSD) affects menopausal women. Whether the presence of MetS may be linked to a higher risk of FSD in menopausal women is unknown. THE AIMS OF OUR STUDY WERE: (i) to evaluate the prevalence of FSD in women with MetS (based on National Cholesterol Education program-Adult Treatment Panel III 2009 criteria) in comparison with healthy controls and (ii) to evaluate the influence of singular components of MetS on female sexual function. METHODS: The Female Sexual Function Index (FSFI) questionnaire, the Female Sexual Distress Scale (FSDS), and The Middlesex Hospital Questionnaire were administered to 103 postmenopausal women with MetS and 105 healthy postmenopausal controls (HC). Female sexuality was defined as dysfunctional when FSFI score was <23 and FSDS was >15. MAIN OUTCOME MEASURES: FSFI and FSDS were completed by women with and without MetS. RESULTS: The prevalence of women with sexual dysfunction was higher in MetS women than HC (39/103 [37.9%] vs. 20/105 [19%], P = 0.003). The prevalence of both pathological scores in every FSFI domain and FSDS score was higher in MetS women than HC. The logistic regression, considering age and the length of relationship as a common starting point, shows that higher levels of triglycerides are linked to a higher risk of presenting FSD (odds ratio = 2.007 95% confidence interval [1.033-3.901]) in the whole population. CONCLUSIONS: Our preliminary results suggest that prevalence of FSD is higher in women with MetS in comparison with healthy controls. Higher levels of triglycerides are linked to a higher risk of presenting FSD.

Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question.

OBJECTIVE: To evaluate the feasibility of the hysteroscopic resection of type II submucous fibroids regardless of the myometrial free margin separating them from the serosa and to report the dynamic changes the margin undergoes after the various phases of resection. DESIGN: A prospective observational study. SETTING: A tertiary-level university hospital. PATIENT(S): Thirteen women with single type II submucous fibroids of ≤ 5 cm in diameter regardless of the myometrial free margin. INTERVENTION(S): Hysteroscopic myomectomy and ultrasound evaluation of myometrial free margin before and after each phase of the procedure. MAIN OUTCOME MEASURE(S): The possibility of a complete one-step resection, the incidence of intraoperative or postoperative complications, and the analysis of the dynamic changes occurring in myometrial free margin. RESULT(S): Complete resection was performed successfully in all patients. No complications were registered. The myometrial free margin decreased on the distension of the uterine cavity and then increased progressively and significantly after the various phases of resection. CONCLUSION(S): In selected cases and in experienced hands, hysteroscopic myomectomy of type II submucous fibroids may be performed successfully and safely regardless of the myometrial free margin. Myometrial free margin increases progressively with each step of the procedure probably leading to an increasing margin of safety.

Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring.

Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome Measure(s). The procedure was performed without incident. The trocar placement was easy and safe, without inadvertent port removal. No vascular or visceral injuries, loss of pneumoperitoneum, or intraoperative port site bleeding occurred. Result(s). A detailed description of the technique of a single-site surgery for management of hysterectomy and BSO. Conclusion. Our case presents the first report of single-site surgery for surgical treatment of subjects affected by GID.

Unilaterally increased uterine artery resistance, placental location and pregnancy outcome.

OBJECTIVE: To evaluate the outcome of pregnancies with second trimester unilaterally increased uterine artery resistance. STUDY DESIGN: Between January 2007 and December 2009 all low-risk patients with unilateral increase of uterine artery pulsatility index (PI) but normal mean pulsatility at 20-22 weeks of gestation were included in the study group. Among these, cases with central placenta (group A) were distinguished from those with lateral placenta (group B). A control group was selected among patients with bilaterally normal uterine artery PI. Pregnancy outcome was considered for all cases and compared with controls. RESULTS: In the study period, 131 patients with second trimester unilaterally increased uterine artery PI were identified. Placental location was central in 67 (51.1%) patients (group A) and lateral in 64 (48.9%) patients (group B). In the study group (n=131) compared to controls (n=131), mean gestational age at delivery (38.9 ± 1.4 weeks vs. 38.8 ± 1.6 weeks; p=0.43), mean birth weight (3251 ± 445 vs. 3276 ± 388; p=0.63), Z-score of birth weight (-0.17 ± 0.87 SD vs. -0.04 ± 0.69 SD; p=0.19), occurrence of pre-eclampsia (4/131 vs. 3/131; p=1), low birth weight (7/131 vs. 7/131; p=1) and caesarean section due to fetal distress (9/131 vs. 6/131; p=0.5) were not significantly different. The same variables were compared within the study group between cases with central (group A) vs. lateral (group B) placenta and none of them was significantly different. CONCLUSION: Patients with unilaterally abnormal uterine artery pulsatility, but normal mean PI, do not seem at increased risk for obstetric and perinatal complications, irrespectively of placental location.

Mode of delivery in the preterm gestation and maternal and neonatal outcome.

OBJECTIVE: To determine if the mode of delivery in preterm gestations is associated with changes in maternal and neonatal outcome. METHODS: A retrospective cohort study that included all singleton deliveries occurring after spontaneous onset of labour between 25+0 and 32+6 weeks of gestation. Cases of early preterm delivery were identified from clinical records and classified according to the mode of delivery. The following outcomes were derived for each case and compared between caesarean and vaginal deliveries: perinatal death, cranial findings compatible with haemorrhage or white matter disease in the neonate, new-onset of maternal severe anaemia or pyrexia. RESULT: From 1990 to 2007, 109 cases of spontaneous preterm labour were retrospectively selected, including 50 (45.8%) caesarean sections and 59 (54.2%) vaginal deliveries. Perinatal death occurred in 10 infants (9.1%), whereas among survivors abnormal cerebral findings were detected in 20, including 6 cases with haemorrhage, 12 with white matter findings and 2 with both. At multiple logistic regression, a birthweight lower than 1100 g was the only predictor of all adverse outcomes, whereas male sex increased the risk of white matter findings. Caesarean section compared to vaginal delivery conferred a higher risk of maternal complications (23/50 or 46% vs. 6/59 or 10.2%; OR: 11.9, CI 95%: 4.2-333; p<0.0005). CONCLUSIONS: In severely premature infants born after spontaneous onset of labour, the risk of adverse perinatal outcome does not seem to depend upon the mode of delivery, whereas the risk of maternal complications is significantly increased after Caesarean section.

The impairment of sexual function is less distressing for menopausal than for premenopausal women.

INTRODUCTION: Menopause requires psychological and physical adjustments because of the occurring significant hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes women do not regard sexual changes as problematic and often readjust their life and relationship according to their new physical status. AIM: The aim of our study was to evaluate sexual function and the way women feel by comparing healthy postmenopausal and premenopausal women. METHODS: One hundred menopausal (M) and 100 premenopausal (pM) healthy women were asked to complete anonymous questionnaires to assess sexual function and stress related to sexual activity. MAIN OUTCOME MEASURES: Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) were completed by M and pM women. Results. Medium FSFI score was 20.5 +/- 9.6 and 26.4 +/- 7.7 (P < 0.0005) and medium FSDS score was 12.1 +/- 11.7 (95% CI 9.7-14.4) and 11.3 +/- 10.2 (P = 0.917) for M and pM women, respectively. Twenty-five of the 69 M women and 20 of the 31 pM women with a pathological score in the FSFI questionnaire scored higher than 15 in the FSDS (P < 0.0005). The overall prevalence of sexual dysfunction was 20% and 25% (P = 0.5) in the M and pM women. CONCLUSIONS: Our data confirm that menopause is associated with changes in sexual function that may be compatible with sexual dysfunction. However, personal distress caused by these changes in sexual life appears to be lower among menopausal women (36.2%) as compared with premenopausal women (64.5%). These data suggest that medical treatment for sexual health in menopause must be highly personalized and carefully prescribed.

Neonatal hypoxic-ischemic encephalopathy in apparently low risk pregnancies: retrospective analysis of the last five years at the University of Bologna.

OBJECTIVE: To provide recent figures on the occurrence of neonatal hypoxic-ischemic encephalopathy (NHIE) from a Teaching Hospital. STUDY DESIGN: A retrospective case-control study was conducted in a tertiary level university hospital with more than 3000 deliveries annually. Twenty-four cases of NHIE that occurred in apparently low-risk pregnancies were analysed and compared to a group of controls for the most common labor variables. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS: Of 15,371 apparently low-risk deliveries, 24 cases of NHIE were observed (0.16%), with perinatal death or cerebral palsy occurring in nine of these cases (0.06%). The following intra-partum variables were significantly more common in cases than in controls: stained amniotic fluid (OR: 7.50; 95% CI:1.77-31.79), maternal fever (none in the control group), abnormal CTG (OR: 253.0; 95% CI: 26.70-2397), persistent occiput posterior (OR: 15.67; 95% CI: 2.25-104.53) and operative delivery (OR: 3.98; 95% CI: 1.39-11.33). CONCLUSION: The incidence of NHIE is considerably low in a Tertiary care Centre.

Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals.

INTRODUCTION: Long term safety of testosterone (T) administration in women is still unknown. In particular few and discordant data exists on the effects of T on the endometrium. AIM: The aim of this study was to investigate the effects of long-term T treatment on endometrium histology and proliferation in female to male transsexual subjects (FtM). We compared these endometria with those of young women in the proliferative phase (PM) of the cycle and with those of post menopausal women (M). METHOD: Endometrial samples from 27 FtM treated with T (intramuscular injection of 100 mg Testoviron Depot /10 days for at least one year), 30 M undergoing vaginal hysterectomy, and 13 PM undergoing hysteroscopy for infertility problems were collected. Endometrial proliferation was evaluated on the basis of histopathology and expression of the proliferation marker Ki-67. Both M and PM women had not received any hormonal treatment for at least one year. MAIN OUTCOME MEASURE: Circulating total testosterone (TT), estradiol (E), progesterone (P), insulin and glucose levels were measured in FtM and PM subjects. RESULTS: FtM had received T for 33.6 +/- 21.3 months (mean +/- SD). In FtM subjects, histological analysis found inactive endometrium similar to the atrophic menopausal endometrium. The expression of Ki-67 in the glands, stroma and glands and stroma together was significantly (p < 0.0005) lower in FtM than in PM women and was similar in the FtM and M groups. Small polyps were detected in 5 of the 27 FtM subjects. CONCLUSIONS: In conclusion our data suggest that exogenous T administration does not stimulate endometrial proliferation in FtM transsexuals and indeed may have atrophic effects.

Laparoscopic treatment of interstitial twin pregnancy.

OBJECTIVE: To describe a conservative management by laparoscopy of an unusual interstitial twin pregnancy. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old woman, pregnant at 6th week of amenorrhea with interstitial twin pregnancy. INTERVENTION(S): The woman was submitted to two- and three-dimensional transvaginal ultrasound and to diagnostic hysteroscopy. Subsequently, we performed a laparoscopic procedure: conical exeresis of the uterine cornu using a monopolar hook without involving the uterine cavity. MAIN OUTCOME MEASURE(S): Conservation of the uterus, fertility preservation. RESULT(S): Successful conservative treatment of interstitial twin pregnancy. CONCLUSION(S): Conservative laparoscopic surgery can be used successfully in hemodynamically stable patients with an interstitial pregnancy.

The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia.

OBJECTIVE: To evaluate the usefulness of uterine artery Doppler in the prediction of outcome in patients with late-onset preeclampsia. STUDY DESIGN: Patients with late-onset preeclampsia underwent Doppler interrogation of the uterine arteries. Patients with abnormal uterine artery Doppler were compared with those who had a normal uterine artery Doppler. RESULTS: Ninety-nine patients were included in the study group. Abnormal uterine artery Doppler group presented significantly lower gestational age at admission (36.1 +/- 2.1 weeks vs 37.2 +/- 1.9 weeks; P < .005), lower gestational age at delivery (36.5 +/- 1.9 weeks vs 37.7 +/- 1.7 weeks; P < .005), lower birthweight (2429 +/- 590 g vs 3013 +/- 597 g; P < .0001), and a higher admission rate to neonatal intensive care unit (17/51 vs 6/48; odds ratio, 3.5; 95% confidence interval, 1.2-9.5). No significant difference in the occurrence of maternal complications (10/51 vs 6/48; odds ratio, 1.7; 95% confidence interval, 0.5-4.9) was registered. CONCLUSION: Women with late-onset preeclampsia show a higher risk of perinatal complications if uterine resistance is increased although maternal outcome does not seem to be related to Doppler findings.

Outcome of conservatively treated microinvasive squamous cell carcinoma of the uterine cervix during a 10-year follow-up.

UNLABELLED: To assess the rate, the cumulative proportion, and the predictors of cervical intraepithelial neoplasia grades 2-3 (CIN 2-3) and invasive disease during the follow-up of patients conservatively treated for microinvasive (stage Ia1-2) squamous cell carcinoma (MIC) of the uterine cervix. METHODS: Two hundred thirty women (median age, 37 years; range, 20-69 years) conservatively treated for MIC were followed up for 10 years and analyzed for cumulative proportion of CIN 2-3/invasive disease. The multivariate survival analysis was used to assess the clinicopathological features predicting the development of CIN 2-3/SCC. RESULTS: Of the 230 patients primarily treated by cone, 76 (33%) underwent hysterectomy as the immediate retreatment, and 13 had a residual disease. The remaining 154 women were subjected to posttreatment follow-up. The depth of stromal invasion was strongly associated with the prevalence of positive lymph nodes and lymphovascular space invasion (LVSI). The detection rate of CIN 2-3/SCC was stable at the first 2 visits (6.5% and 6.9%) and dropped thereafter. The cumulative proportion of patients whose conditions were diagnosed as CIN 2-3/carcinoma was 0.07, 0.09, 0.15, and 0.19 at 6, 12, 36, and 120 months, respectively. In multivariate survival analysis, involvement of 4 quadrants (odds ratio [OR], 5.8), LVSI (OR, 4.5), and cone margin involvement (OR, 5.6) were significant independent predictors of CIN 2-3/SCC after treatment. The upper age tertile (42-69 years) was an independent protective factor (OR, 0.3; 95% confidence interval, 0.1-0.9). CONCLUSIONS: A close, long-term surveillance should be scheduled for the MIC patients conservatively treated. Cone margin involvement, LVSI, and the number of quadrants involved on colposcopy are independent risk factors for disease persistence and/or progression to SCC.

Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies.

OBJECTIVE: To assess the accuracy of three-dimensional (3D) ultrasound in the diagnosis of congenital uterine anomalies. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Nulliparae with three or more consecutive miscarriages. INTERVENTION(S): All women underwent 3D transvaginal ultrasound study of the uterine cavity. MAIN OUTCOME MEASURE(S): Women with negative ultrasound findings subsequently underwent office hysteroscopy, whereas a combined laparoscopic-hysteroscopic assessment was performed in cases of suspected Müllerian anomaly. RESULT(S): A specific Müllerian malformation was sonographically diagnosed in 54 women of the 284 included in the study group. All negative ultrasound findings were confirmed at office hysteroscopy. Among the women with abnormal ultrasound findings, the presence of a Müllerian anomaly was endoscopically confirmed in all. Concordance between ultrasound and endoscopy around the type of anomaly was verified in 52 cases, including all those with septate uterus and two out of three with bicornuate uterus. CONCLUSION(S): Volume transvaginal ultrasound appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies and may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a history of recurrent miscarriage.

Effects of testosterone undecanoate administered alone or in combination with letrozole or dutasteride in female to male transsexuals.

INTRODUCTION: Testosterone undecanoate (TU) has potential as androgen therapy for ovariectomized female to male (FtM) transsexual subjects; however, the long-term physiologic effects of TU treatment, the significance of testosterone (T), and the T metabolites dihydrotestosterone (DHT) and estradiol (E) on specific outcome parameters are currently unknown. AIM: The aim of this study was to investigate the long-term treatment of TU with regard to bone metabolism, body composition, and lipid profile in FtM subjects, and to evaluate the relationship between observed effects and circulating levels of T, E, and DHT. MAIN OUTCOME MEASURES: Circulating follicle-stimulating hormone, luteinizing hormone, T, E, DHT, and lipid concentrations were measured, as well as bone metabolism, body composition, and insulin resistance. METHODS: This was a 1-year, randomized treatment, open-label, uncontrolled safety study. Fifteen ovariectomized FtM subjects from an outpatient clinic were divided into three groups to receive TU 1,000 mg alone or in combination with oral administration of letrozole (L) 2.5 mg/die or dutasteride (D) 0.5 mg/die for a period of 54 weeks. RESULTS: TU alone and TU + D treatments were successful in terms of hormone adjustment, did not result in any adverse effects, and were well-tolerated. Bone mineral density decreased by an average of 0.9 g/cm(2) in the TU + L group, and the addition of D resulted in a failure to gain lean mass. CONCLUSIONS: This study confirmed that TU is a successful and safe treatment for FtM subjects. These data indicate that E has an important role in bone metabolism and that DHT may play a role in muscle metabolism.

Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer.

OBJECTIVES: The aims of our study were to evaluate the possibility of identifying the sentinel lymph node (SLN) in patients with endometrial cancer (EC) and to directly compare two injection techniques, cervical and hysteroscopic injection. METHODS: Fifty-four patients with endometrial carcinoma, clinical stages I and II, were submitted to complete surgical staging through laparoscopy, as recommended by FIGO in 1988. For the mapping procedure the patients were divided into two groups of injection: the cervical injection group and hysteroscopic injection group. Technetium (Tc) 99m radiocolloid was used as tracer. RESULTS: Intraoperative detection rate of SLN was 70% in cervical group and 65% in the hysteroscopic group (p=n.s.). In the cervical group, all patients had SLN in the pelvis only and the mean SLN removed was 18 (range 2-26). In the hysteroscopic group, all patients had SNLs in the pelvis and two patients had SLN both in the pelvis and above the bifurcation of the aorta. Mean pelvic SLN removed was 20 (range 8-42). CONCLUSIONS: Our data shows that it is possible to identify the SLN in tumours of the endometrium. Both cervical and hysteroscopic techniques are feasible but the hysteroscopic procedure might represent the only method able to highlight the complete lymphatic drainage of the uterus as suggested by the presence of paraaortic positive SLN only in this group.

Diagnostic accuracy of 18F-FDG PET/CT in characterizing ovarian lesions and staging ovarian cancer: correlation with transvaginal ultrasonography, computed tomography, and histology.

AIMS: To (a) assess the accuracy of 18F-FDG PET/CT in distinguishing malignant from benign pelvic lesions, compared to transvaginal ultrasonography (TVUS) and (b) to establish the role of whole-body 18F-FDG PET/CT, compared to contrast enhanced computed tomography (CT), in staging patients with ovarian cancer. PATIENTS: Fifty consecutive patients with a pelvic lesion, already scheduled for surgery on the basis of physical examination, TVUS, and serum Ca125 levels, were enrolled in the study. Patients' age ranged between 23 and 89 years (mean 64). All patients underwent TVUS including a colour Doppler study followed by a thorax and abdominal CT scan, and whole-body 18F-FDG PET/CT within 2 weeks prior to surgery. Histological findings obtained at surgery were taken as the 'gold standard' to compare 18F-FDG PET/CT and TVUS, and 18F-FDG PET/CT vs. CT. When tissue analysis showed ovarian cancer, the accuracy of 18F-FDG PET/CT and CT were compared for the purpose of obtaining a precise staging. RESULTS: At surgery, the ovarian lesions were malignant in 32/50 patients (64%) and benign in the remaining 18/50 patients (36%). The sensitivity, specificity, NPV, PPV and accuracy of 18F-FDG PET/CT were 87%, 100%, 81%, 100% and 92%, respectively, compared with 90%, 61%, 78%, 80% and 80%, respectively, for TVUS. In staging ovarian cancer, 18F-FDG PET/CT results were concordant with final pathological staging in 22/32 (69%) patients while CT results were concordant in 17/32 (53%) patients. CT incorrectly down-staged four out of six stage IV patients by missing distant metastasis in the liver, pleura, mediastinum, and in left supraclavicular lymph nodes, which were correctly detected by 18F-FDG PET/CT. CONCLUSION: PET/CT with 18F-FDG provides additional value to TVUS for the differential diagnosis of benign from malignant pelvic lesions, and to CT for the staging of ovarian cancer patients.

Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix.

OBJECTIVE: The present study assessed (i) the clinical outcome of patients with conservatively treated cervical adenocarcinoma in situ (AIS), (ii) the accuracy of diagnosing AIS by cytology, colposcopy and histology, as well as (iii) the performance of cervical cytology and HPV testing in detection of residual or recurrent disease after conservatively treated AIS. METHODS: A series of 42 consecutive women (mean age 40.5 years; range 27-63 years) underwent conservative (cone) treatment of AIS and were prospectively followed up for a mean of 40 months (median 42 months), using colposcopy, PAP smear, biopsy and HPV testing (with hybrid capture II) repeated at 6-month intervals. RESULTS: In their referral PAP test, only 42.9% of patients had atypical glandular cells (AGC) smear. Colposcopy was unsatisfactory in 54.8% cases and negative in 16.7%. Twenty four patients (57.1%) had AIS as a pure lesions and 18 combined with squamous cell lesion (four had invasive SCC). Persistent or recurrent disease was observed in 17 (40.4%) cases, 19% in patients with free margins, and 65% among those with involved margins on the first conization. In four patients, an adenocarcinoma (AdCa) stage IA1 was diagnosed during the follow-up. HPV testing significantly predicted disease persistence/clearance with OR 12.6 (95% CI 1.18-133.89), while the predictive power of PAP smear did not reach statistical significance at any of the follow-up visits. The combination of PAP smear and HPV testing gives SE of 90.0%, SP 50.0%, PPV 52.9% and NPV 88.9% at first follow-up, and 100% SE and 100% NPV at the second follow-up visit. CONCLUSIONS: These results suggest that HR-HPV test in conjunction with cytology offers clear advantages over single cytology in monitoring the women conservatively treated for cervical AIS.

Nuchal cord entanglement and outcome of labour induction.

AIM OF THE STUDY: To assess whether nuchal cord entanglement would affect the outcome of elective labour induction. METHOD: In a group of pregnant women, the outcome of elective labour induction was evaluated in relation to a list of possibly related variables, including the presence of nuchal cord at delivery. RESULTS: Overall 184 women submitted to induction of labour were prospectively examined. Vaginal delivery was observed in 141 women (76.6%), with 105 of them (or 57%) having been delivered within 24 h from induction. At delivery, nuchal cord was detected in 59 out of 184 neonates (32%). Among the pre-induction and post-induction variables, only parity ≥ 1 (OR 3.44; 95% CI: 1.67-7.06) and a Bishop score ≥ 5 (OR 3.59; 95% CI: 1.93-6.70) appeared statistically associated with the success of induction. The chance of vaginal delivery within 24 hours from labour induction (31/59 or 53% vs 74/125 or 59%; OR: 0.92; 95% CI: 0.75-1.12) were comparable among the neonates with and without nuchal cord at birth. CONCLUSIONS: In women undergoing cervical ripening, multiparity and a favourable cervical score seem the only factors that predict a successful induction. An entangled cord around the fetal neck does not seem to increase the risk of induction failure.

Testosterone decreases adiponectin levels in female to male transsexuals.

AIM: To evaluate the effect of testosterone (T) on adiponectin serum levels in transsexual female patients. METHODS: We measured adiponectin, leptin, luteinizing hormone and follicle stimulating hormone, T, estradiol, lipid profile, biochemical parameters and body composition in 16 transsexual female patients at baseline and after 6 months of T treatment (100 mg Testoviron Depot /10 days, i.m.). RESULTS: Adiponectin levels were 16.9 +/- 7.3 mg/mL at baseline and 13.5 +/- 7.4 mg/mL at month 6 of T treatment (P < 0.05). Leptin and high-density lipoprotein cholesterol decreased significantly, whereas body mass index, waist circumference and lean body mass increased significantly after 6 months of T treatment. No changes in insulin or Homeostasis Model Assessment were detected. CONCLUSION: T can significantly reduce adiponectin serum levels in transsexual female patients.

Advances in male hormonal contraception.

There is a need to develop new contraceptives, particularly for men whose current choices are suboptimal in terms of effectiveness and ease of reversibility. Recent surveys indicate that men and their partners would be willing to rely on male hormonal contraceptives. Male hormonal contraception works by reversibly suppressing sperm production. Testosterone in combination with progestins or gonadotropin-releasing hormone antagonists induces profound and consistent sperm suppression. Asian men are more susceptible to the suppressive effects of testosterone given alone, even if they may benefit from the addition of an adjunctive agent to obtain optimal contraceptive protection. The aim of this review is to comment on the recent relevant achievements in the field.