Comparison of the effects of acarbose and metformin use on ovulation rates in clomiphene citrate-resistant polycystic ovary syndrome.

BACKGROUND: The aim of this study was to evaluate the effects of metformin and acarbose on insulin resistance, hormone profiles and ovulation rates in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). METHODS: Thirty clomiphene citrate-resistant patients were selected randomly and divided into two groups. Group I was treated with 100 mg/day clomiphene citrate and 300 mg/day acarbose 100 mg/day orally, for 3 months. Group II was treated with clomiphene citrate 100 mg/day and metformin 1700 mg/day orally, for 3 months. Serum fasting insulin and glucose, FSH, LH, estradiol, progesterone, prolactin and total testosterone levels plus body mass index (BMI) were measured before and after treatment. Follicle growth was followed by transvaginal ultrasonography. RESULTS: LH:FSH ratio and total testosterone concentrations decreased (P<0.05) and ovulation rates increased in both groups. Reduction in weight and BMI was only significant in the acarbose group. CONCLUSIONS: Both treatment modalities were effective in the treatment of insulin resistance and improving ovulation rates. Increase in the number of eumenorrhoeic and normoinsulinaemic cases and decrease in the number of insulin-resistant cases were significant in both groups (P<0.05). Ovulation rate was greater in the metformin group in the second month of therapy (P<0.05). Acarbose was found to be a safe and effective agent that could be used in cases with clomiphene-resistant PCOS.

Effects of misoprostol on lipoprotein (a) levels of ovariectomized rats.

OBJECTIVE: To determine the effects of misoprostol on plasma lipoprotein (a) concentrations of ovariectomized rats. DESIGN: Controlled prospective study. SETTING: Animal research laboratory. ANIMAL(S): Four-month-old female Sprague-Dawley rats. INTERVENTION(S): Blood samples were obtained before and 60 days after ovariectomy, and the rats were divided into three groups. Group I (five rats) was treated with vehicle (water); groups II and III (nine and eight rats, respectively) were treated with oral misoprostol at 100 and 200 microg/kg/d, respectively, for 60 days, after which blood was drawn again. MAIN OUTCOME MEASURE(S): Serum lipoprotein (a) levels. RESULT(S): The median lipoprotein (a) level before ovariectomy was 10.8 mg/dL (range, 10.6-46.5 mg/dL). Sixty days after ovariectomy, the level increased significantly to 15.9 mg/dL (range, 10.6-36.9 mg/dL). After treatment, there was no change in lipoprotein (a) levels in the vehicle-treated group (range, 16.3-21.1 mg/dL); however, the lipoprotein (a) levels decreased significantly in the group treated with 100 microg/kg/d of misoprostol, from 15.4 mg/dL to 10.8 mg/dL, and in the group treated with 200 microg/kg/d of misoprostol, from 17.1 mg/dL to 10.6 mg/dL. CONCLUSION(S): Misoprostol caused a significant decrease in lipoprotein (a) levels.

Effects of misoprostol on bone loss in ovariectomized rats.

This study was performed to investigate whether misoprostol (prostaglandin E1 analogue) (Cytotec, Searle, England) is effective for restoration of bone loss. Four-month-old parous female Sprague-Dawley rats (n = 30) were subjected either to bilateral ovariectomy (OVX, 24 rats) or to sham surgery (sham, 6 rats). The OVX rats were divided into four groups 60 days after the surgery. Six of them were killed, and dual-energy X-ray absorption (Norland xr-36, Norland Corporation, Fort Atkinson, WI, USA) measurements were performed, called pretreatment OVX group. The remaining groups (each had 6 rats) treated orally with 0 (control), 100, 200 micrograms/kg/day misoprostol for 60 days. All rats were killed 60 days after having treatment, and bone loss of the lumbar spine was measured by dual-energy X-ray absorption. The bone mineral density was decreased by 25.4% in control group and 23.6% in pretreatment group compared to sham group, but restored by 86% and 96% in groups treated with 100 and 200 micrograms/kg/day misoprostol, respectively. These results suggest that misoprostol restores bone loss in the lumbar spine of OVX rats in a dose-dependent manner.

Sterilization with fibrin sealant in a rabbit uterine horn model.

OBJECTIVE: This study investigated the effects of a fibrin sealant with or without coagulation in obliterating the tubal lumen at the uterotubal junction in rabbits. STUDY DESIGN: Twenty-three female rabbits were subjected to laparotomy and hysterotomy. They were randomly divided into four groups, and the fallopian tubes underwent different treatment: In group 1 (n = 14) both bipolar coagulation and the fibrin sealant were used. In group 2 (n = 10) only fibrin sealant without coagulation was used. In group 3 (n = 11) only coagulation was used. In group 4 (n = 10) no treatment was performed (control group). Two to three rabbits were euthanized on days 3 to 4, 7 to 11, 14 to 17, and 21 to 24 postoperatively. Both uterotubal junctions were excised, and step cross sections were obtained. The morphologic features including denuded epithelium with debris, submucosal fibrosis, hemorrhage, and fibrinoid matter in the tubal lumen and occluded lumen were observed. RESULTS: Tubal lumina were successfully occluded in 10 of 14 tubes (71.4%) in group 1. In groups 2 and 4 none of the tubes were occluded, and in group 3 only three tubes were partially occluded. The difference between group 1 and other groups was significant (p < 0.05). CONCLUSIONS: The effects of bipolar coagulation in enhancing the inflammatory reaction on the mucosa and scar formation induced by fibrin sealant at the uterotubal junction in the rabbit were demonstrated. This sterilization method with the use of fibrin sealant may be developed into an outpatient procedure in humans and may be a new method for female sterilization in the future.

Cervical pregnancy: can age and parity be predisposing factors?

A fifty-year old woman, gravida 17, para 17, presented with profuse vaginal bleeding following curettage in another hospital. At emergency laparotomy total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed because of intractable hemorrhage. Histopathologic examination revealed endocervical placentation and adenomyosis uteri. The case is presented due to its rarity and possible predisposing factors are discussed.