Search

Cardiovascular diseases (CVD) and diabetes still represent the main cause of mortality and morbidity in the industrialized world. Low birth weight (LBW), caused by intrauterine growth restriction (IUGR), was recently known to be associated with increased rates of CVD and non-insulin dependent diabetes in adult life (Barker's hypothesis). Well-established animal models have shown that environmentally induced IUGR (diet, diabetes, hormone exposure, hypoxia) increases the risk of a variety of diseases later in life with similar phenotypic outcomes in target organs. This suggests that a range of disruptions in fetal and postnatal growth may act through common pathways to regulate the developmental programming and produce a similar adult phenotype. The identification of all involved signaling cascades, underlying the physiopathology of these damages in IUGR fetuses, with their influence on adult health, is still far from satisfactory. The endothelium may be important for long-term remodeling and in the control of elastic properties of the arterial wall. Several clinical and experimental studies showed that IUGR fetuses, neonates, children and adolescents present signs of endothelial dysfunction, valuated by aorta intima media thickness, carotid intima media thickness and stiffness, central pulse wave velocity, brachial artery flow-mediated dilation, laser Doppler skin perfusion and by the measure of arterial blood pressure. In utero identification of high risk fetuses and long-term follow-up are necessary to assess the effects of interventions aimed at preventing pregnancy-induced hypertension, reducing maternal obesity, encouraging a healthy life style and preventing childhood obesity on adult blood pressure and cardiovascular disease in later life. [ABSTRACT FROM AUTHOR]

Enhanced biosynthesis of several cytokines, such as, transforming growth factor-β1 (TGF-β1), is detected in gestational diabetes mellitus (GDM). In this study, we addressed the question of whether the exposure to the abnormal milieu of GDM in vivo affects gene expression pattern of human umbilical vein endothelial cells (HUVEC) in response to TGF-β1. We found that HUVEC isolated from GDM (dHUVEC) had reduced migratory capacity versus those of healthy women (nHUVEC) and this quiescent phenotype was associated with higher expression levels of the TGF-βtype I receptor ALK5 and a slight increase in the endogenous production of TGF-β1 (mainly in its latent form). Moreover, we performed transcriptome analysis, using microarray technology, of dHUVEC versus nHUVEC, after 3 h treatment with exogenous TGF-β1 (10 ng/ml). The treatment of dHUVEC with TGF-β1 caused downregulation of the transcription of multiple genes involved in development, cell movement and migration of cells versus TGF-β1-treated nHUVEC. These changes in transcriptome profile might contribute to GDM-dependent alterations in cardiac morphogenesis and placental development. [ABSTRACT FROM AUTHOR]

Endometriosis is a benign gynecologic disease defined as the presence of functional endometrial glands and stroma outside the uterine cavity, causing dysmenorrhea, dyspareunia, menstrual irregularities, and infertility. Serum CA-125 measurement is now a consolidated method for diagnosing this condition, and its interpretation has posed a number of problems, particularly regarding utility in diagnosing minimal-mild endometriosis, whereas its value as a diagnostic aid in moderate-severe stages is well recognized. In our cohort, serum CA-125 values were significantly elevated in patients with ovarian and mixed endometriosis lesions (median levels 48 U/mL), compared with those who had exclusively extraovarian foci (median levels 27 U/mL), and so the correlation between this marker and the surgical and pathologic finding of ovarian and deep endometriosis was found to be statistically significant; however, the location did not affect the fertility rate. [Copyright &y& Elsevier]

Pelvic inflammatory disease (PID), like many other inflammatory diseases, can be characterized by an inflammation-induced activation of the coagulation cascade, resulting in the production of d-dimers. In this study it is demonstrated how high levels of d-dimers, assayed at the time of hospitalization, are encountered in patients diagnosed with PID and how the levels of this parameter are significantly higher in patients, which due to the severity of the disease, needed surgical treatment. Therefore the d-dimer is shown to be an important parameter to be considered in the therapeutic counseling of severe forms of PID. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Hysteroscopic endometrial resection is an innovative and conservative surgical technique considered, very often, as an alternative to hysterectomy. The aim of the study was to evaluate long-term efficacy of endometrial resection performed in women with menorrhagia. Study design: Retrospective study of 111 premenopausal women with menorrhagia, unresponsive to medical treatment, who underwent endometrial resection by resectohysteroscope (electrocautery technique supplied with a fundus rollerball electrode, with corneal areas, and with a 90° loop for intrauterine walls and used with glycine 1% as distending fluid) between 1994 and 1999. Results: Long-term follow-up questionnaires were completed in 106 cases, while 5 cases dropped-out (4.5%). The mean-age at menopause in our subjects was 52.8 years (17.6±18.4 months after operation). After 53.2±16.4 months, 82 patients (77.4%) showed a normal menstrual pattern or amenorrhea, while failure was recorded in 24 patients (22.6%) and 12/24 patients underwent hysterectomy. Percentage of success in the older population (>49 years) (94%) was significantly higher than in the younger population (70%). The histologic finding of only fibrosis (41.7%) correlated with failure of the technique. Conclusion: Our data suggest that endometrial resection by resectohysteroscope is an innovative and conservative but not exclusive surgical technique in selected younger women, while in older women endometrial resection nearly always resolves long-term menorrhagia. [Copyright &y& Elsevier]

To study the effect of growth factors on iatrogenic apoptosis, we examined the influence of vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) on staurosporine-induced apoptosis in primary cultures of human umbilical vein endothelial cells (HUVEC). Apoptosis was evaluated by a cell viability test, the TUNEL-POD assay and the activation of the pro-apoptotic caspase-3. Staurosporine (10–100 nM) caused the activation of caspase-3. This effect was manifest after 2 hr of incubation and reached its maximum after 5 hr. Severe loss of viability followed within 18 hr. VEGF or EGF (10–100 ng/mL) added together with staurosporine decreased the activation of caspase-3. The loss of viability was 24 hr delayed. The action of growth factors was observed at 1% serum concentration but also at concentration optimal for HUVEC survival (10%, v/v). Furthermore, the inhibition of PI-3 kinase (PI-3K) by wortmannin or LY294002 as well as the inhibition of MEK by PD098059 or U0126 prevented the protective effect of VEGF and EGF. Western blotting analysis showed that after 3 hr of incubation with staurosporine the level of the anti-apoptotic protein Mcl-1 decreased and this effect was reverted by VEGF. It is concluded that VEGF and EGF antagonize the pro-apoptotic action of staurosporine by the combined signalling of PI-3K and ERKs pathways. [Copyright &y& Elsevier]

: ObjectiveTo evaluate the side effects and complications of, difficulties with, and possible solutions to the problems associated with sonohysterosalpingography.: DesignProspective study.: SettingUniversity hospital.: Patient(s)One thousand, one hundred fifty-three patients who underwent sonohysterosalpingography to investigate abnormal uterine bleeding, infertility, thick endometrium at transvaginal ultrasonography, mu¨llerian abnormalities, or the Asherman syndrome.: Main outcome measure(s)Side effects and complications of and difficulties related to the procedure. Tolerance was assessed by using a pain-rating scale.: Result(s)Ninety-three percent (1,074 of 1,153) procedures were performed correctly. Investigation was not completed in 79 (7%) women; a second attempt was successful in 60 of these patients. Side effects, such as moderate or severe pelvic pain, vasovagal symptoms, nausea, and vomiting, occurred in 102 (8.8%) women. Such complications as fever and peritonitis occurred in 0.95% of patients.: Conclusion(s)Sonohysterosalpingography is a simple, safe, and well-tolerated technique that has a low rate of side effects and rare complications. [Copyright &y& Elsevier]

: ObjectiveTo evaluate the efficacy of a new technique, the sonovaginography, for the assessment of rectovaginal endometriosis.: DesignProspective study.: SettingUniversity hospital.: Patient(s)Forty-six women were scheduled for laparotomic or laparoscopic surgery because of rectovaginal endometriosis suspected on the basis of patient history and/or clinical examination.: Intervention(s)Before surgery, all the women underwent transvaginal ultrasonography and then sonovaginography. The latter is based on transvaginal ultrasonography combined with the introduction of saline solution to the vagina that creates an acoustic window between the transvaginal probe and the surrounding structures of the vagina. Ultrasound findings were compared with the results of surgical exploration and histological examination.: Main outcome measure(s)We assessed the accuracy of transvaginal ultrasonography and of sonovaginography for the detection and the location and extension assessment of rectovaginal endometriotic lesions, as well as compared patient compliance between the procedures.: Result(s)Sonovaginography diagnosed rectovaginal endometriosis more accurately than did transvaginal ultrasonography, with a sensitivity and specificity of 90.6% and 85.7%, respectively, whereas the transvaginal ultrasonography has shown a sensitivity and specificity of 43.7% and 50%, respectively. Patient discomfort did not differ significantly between the procedures.: Conclusion(s)Sonovaginography is a reliable and simple method for the assessment of rectovaginal endometriosis and provides information on location, extension, and infiltration of the lesions, which are important factors in selecting the kind of surgery. [Copyright &y& Elsevier]

Objective: To assess the impact of endometrial scratch injury (ESI) on the outcomes of intrauterine insemination (IUI) stimulated cycles.Design: Systematic review and meta-analysis.Setting: Not applicable.Patient(s): Infertile women undergoing one or more IUI stimulated cycles.Intervention(s): Randomized controlled trials (RCTs) were identified by searching electronic databases. We included RCTs comparing ESI (i.e., intervention group) during the course of IUI stimulated cycle (C-ESI) or during the menstrual cycle preceding IUI treatment (P-ESI) with controls (no endometrial scratch). The summary measures were reported as odds ratio (OR) with 95% confidence-interval (CI).Main Outcome Measure(s): Clinical pregnancy rate, ongoing pregnancy rate, multiple pregnancy rate, ectopic pregnancy rate, miscarriage rate.Result(s): Eight trials were included in the meta-analysis, comprising a total of 1,871 IUI cycles. Endometrial scratch injury was associated with a higher clinical pregnancy rate (OR 2.27) and ongoing pregnancy rate (OR 2.04) in comparison with the controls. No higher risk of multiple pregnancy (OR 1.09), miscarriage (OR 0.80), or ectopic pregnancy (OR 0.82) was observed in patients receiving ESI. Subgroup analysis based on ESI timing showed higher clinical pregnancy rate (OR 2.57) and ongoing pregnancy rate (OR 2.27) in patients receiving C-ESI and no advantage in patients receiving P-ESI.Conclusion(s): Available data suggest that ESI performed once, preferably during the follicular phase of the same cycle of IUI with flexible aspiration catheters, may improve clinical pregnancy and ongoing pregnancy rates in IUI cycles. Endometrial scratch injury does not appear to increase the risk of multiple pregnancy, miscarriage, or ectopic pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To define the role of lower uterine segment (LUS) evaluation at term. Design: Observational case-control study. Setting: University hospital. Patient(s): Ninety-four patients were divided into two groups. Group A consisted of 45 multiparous single fetus pregnant women with up to two previous cesarean sections (CS). Group B consisted of 49 multiparous pregnant women with up to three vaginal deliveries and no uterine scars. Intervention(s): Total LUS and myometrial thickness were measured by sonogram in all patients before undergoing a CS. Main Outcome Measure(s): The primary outcome is a correlation between echographic measurements and features of the LUS at the time of CS. The secondary outcome is a definition of a correlation between the number of previous CS, interdelivery interval time, and features of the LUS (grades I–IV). Result(s): Sonographic measurements revealed significant differences in LUS size and myometrial thickness between the two groups. Grades III and IV of LUS were only observed in group A. An interdelivery interval <18 months, LUS thickness ≤3.0 mm, and myometrial thickness <1.5 mm were statistically significant predictors of LUS grades III and IV. Number of previous CS showed no correlation with surgical LUS status. Conclusion(s): Sonographic evaluation of the LUS may be a noninvasive, reproducible, and safe technique for defining the risk of uterine dehiscence, with a sensitivity of 100% and specificity of 85% (positive predictive value, 45%; negative predictive value, 100%). [ABSTRACT FROM AUTHOR]

Objective: To describe how a hydronephrosis can lead to a difficult differential diagnosis between endometriosis and retroperitoneal fibrosis. Design: Case report. Setting: Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria General Hospital, Negrar, Verona, Italy. Patient(s): The history of a 34-year-old woman revealed the appearance of hydroureteronephrosis on the right side at the 35th week of pregnancy. She had an magnetic resonance imaging scan and was diagnosed with a spread retroperitoneal fibrosis. After 2 months, the patient reported the occurrence of pelvic pain, dyspareunia and dysmenorrhea. She was treated with corticosteroids and tamoxifen with no results. Intervention(s): Laparoscopic surgery. A complete retroperitoneal extirpation was done of an endometriotic nodule of the right broad ligament, near the right ureter (without stenosis). Main Outcome Measure(s): Reduction of pelvic pain. Result(s): She noticed an important decrease of pain. Conclusion(s): The cause of hydronephrosis could be a physiologic hydroureteronephrosis, which is the most common cause of dilatation of the urinary tract in pregnancy. The pain symptoms of the patients seemed to be linked to endometriosis and not to retroperitoneal fibrosis. Magnetic resonance imaging sometimes does not enable a correct diagnosis between these two pathologies. Fertile women with suspected fibrosis should undergo a diagnostic laparoscopy by an expert surgeon in retroperitoneal surgery. [Copyright &y& Elsevier]

Abstract: Background: Acute lymphoblastic leukemia is a malignant disease of the bone marrow in which early lymphoid precursors proliferate and replace normal marrow hematopoietic cells, resulting in a marked decrease in the production of normal blood cells. Case Report: We report a case of isolated ovarian relapse 7 years after the primary diagnosis in a patient, who was seemingly in clinical remission following unilateral ovariectomy and second-line chemotherapy. Conclusion: In contrast to testicular relapse, ovarian relapses in acute lymphoblastic leukemia are rarely reported. Surgical removal of the mass followed by chemotherapy is the therapeutic standard. [Copyright &y& Elsevier]