Use of Chinese herbal medicine 'meizitanc' in pregnancy: report of three cases.

The Chinese herbal medicine 'meizitanc', known as 'LiDa Dai Dai Hua Jiao Nang' (Kunming Dali Industry and Trade, Kunming, Yunnan, China) has been used by many women to support weight loss, even though life-threatening side-effects and deaths have been reported. We report the outcomes of three cases of exposure to 'meizitanc' during early pregnancy. In the first case, the pregnancy continued after the patient stopped taking the drug and at 38 weeks of gestation, the patient delivered a healthy infant. However, in the second and third cases fetal cardiac activities were not detected on obstetric follow-up and both pregnancies were terminated due to missed abortion. To our knowledge, this is the first report of exposure to meizitanc during pregnancy. Although herbal medicines are presumed to be safe because of their natural origin, consumption of such products may be dangerous due to the content of undeclared drugs, adulteration with multiple substances and contamination with toxic metals.

Comparison of the effects of hormone therapy regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women.

INTRODUCTION: Sexual dysfunction is more prevalent in postmenopausal women. AIMS: To prospectively evaluate and compare the effects of hormone therapy (HT) regimens, oral and vaginal estradiol, estradiol + drospirenone and tibolone, on sexual function in healthy postmenopausal women. METHODS: The study included 169 consecutive healthy postmenopausal women, and the women were divided into two groups: 111 women received HT, and 58 women received no treatment and served as a control group. As an HT, 23 women with surgically induced menopause received oral 17-beta estradiol. The rest of the women with natural menopause were prospectively randomized: 22 received oral 17-beta estradiol + drospirenone daily, 42 received oral tibolone, and 24 received vaginal 17-beta estradiol. Sexual function was evaluated with a detailed 19-item questionnaire, the female sexual function index, including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. MAIN OUTCOME MEASURES: The differences in sexual function were compared before and 6 months after the treatment in all women. RESULTS: Total sexual function score increased from 19.81 +/- 7.15 to 22.9 +/- 6.44 in the HT group and decreased from 21.6 +/- 8.69 to 17.6 +/- 5.7 in the control group, revealing a significant difference from baseline to post-treatment between the two groups (P = 0.000). The highest improvement in total score and arousal was achieved with the oral 17-beta estradiol (P = 0.000 and P = 0.000, respectively). The highest improvement in lubrication was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). The highest improvement in orgasm was achieved with the tibolone group (P = 0.000). The highest improvement in pain was achieved with the oral and vaginal 17-beta estradiol groups (P = 0.000). CONCLUSIONS: HT provided significant improvement in sexual function compared to women receiving no treatment, and therefore, HT regimens should be suggested for improvement in sexual functioning of postmenopausal women.

Prevalance of Chlamydia trochomatis, Ureaplasma urealyticum and Mycoplasma hominis infections in the unexplained infertile women.

OBJECTIVE: To prospectively investigate the prevalence of Chlamydia trachomatis (CT), Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) in the cervical canal and pouch of Douglas in unexplained infertile women and compare it to healthy controls in the Turkish population. MATERIALS AND METHODS: A total of 31 women presenting with a history of infertility [n = 24 (77%) primary infertility, n = 7 (23%) secondary infertility] between 20 and 38 years of age and 31 women willing to have tubal ligation between 30 and 41 years of age were consecutively included into this study. Specimens were taken from intra-abdominal washings and from the cervical canal. CT, MH and UU were detected with polymerase chain reaction (PCR). RESULTS: Results of 62 women were analyzed. None of the participants met the criteria for salpingitis during laparoscopy. The most common infection in the cervical canal in both groups was UU, which was detected in 13 cases of infertile patients and 11 controls (P = 0.602). Cervical chlamydial and mycoplasmic infection was detected in one case each in infertile and control patients. Neither MH nor UU were obtained from the pouch of Douglas in both groups. Only CT was present in peritoneal fluid of an infertile woman who had also a concomitant chlamydial infection in the cervical canal. CONCLUSION: Demonstration of cervical colonization of CT by PCR may be a promising method for the detection of asymptomatic pelvic infection in patients with unexplained infertility. However, screening for MH and UU is not cost-effective due to similar low rates of detection.

Excision of endometriotic cyst wall may cause loss of functional ovarian tissue.

Management of ovarian cysts is still controversial especially when dealing with endometriomas. Cyst excision was accepted surgical method by many centers; however, relationship between the excision and the loss of functional ovarian tissue is still uncertain.

Adnexal fascioliasis masquerading as ovarian cancer.

BACKGROUND: Preoperative diagnosis of ovarian cancer is still problematic as multiple disease processes may present with pelvic mass. Fascioliasis is a parasitic disease producing unique clinical manifestations. CASE REPORT: A 49-year-old female patient admitted to our hospital with the complaint of occasional abdominal pain. Pelvic examination revealed a right adnexal mass. Serum CA-125 level was elevated. Explorative laparotomy was performed with the initial diagnosis of ovarian tumor. Final diagnosis was adnexal fascioliasis. CONCLUSION: In the setting of a newly diagnosed pelvic mass, care should be taken when interpreting an elevated CA-125 level. While ovarian cancer is high on the list of differential diagnoses, atypical clinical presentation of fasciola may give rise to a misdiagnosis of malignancy.

Expression of nuclear factor-kappa B and placental apoptosis in pregnancies complicated with intrauterine growth restriction and preeclampsia: an immunohistochemical study.

Preeclampsia affects 7-10% of all pregnancies, and is a major cause of maternal and fetal morbidity and mortality. Although enhanced apoptosis is well known in placentas with preeclampsia, the role of transcription factor nuclear factor-kappa B (NF-kappa B) in the process is still being debated. In this work, we investigate the relationship between NF-kappa B expression and trophoblastic cell apoptosis in pregnancies complicated with preeclampsia or intrauterine growth restriction (IUGR) by immunohistochemical analysis of NF-kappa B and three apoptosis related markers: bcl-2, caspase-3, and M30 CytoDeath antibody that identifies early apoptotic changes in the cytoskeleton related to action of caspase. The study was conducted on placental samples from 19 preeclamptic, 5 IUGR-complicated and 10 normal pregnant women. The three conclusions from the statistical analysis of the data are obtained; (i) Significantly higher expression of NF-kappa B in IUGR-complicated (p = 0.003) and preeclamptic placentas (p = 0.004) than the control placentas, (ii) significantly higher M30 index and caspase 3 expression in IUGR and preeclampsia placentas (p = 0.003), and (iii) decreased expression of bcl-2 in IUGR and preeclampsia placentas (p = 0.001). Based on these observations, we suggest that increased trophoblastic apoptosis is at least partially induced by NF-kappa B and reduced bcl-2 expression.

The effect of carbohydrate intolerance on neonatal birth weight in pregnant women without gestational diabetes mellitus.

BACKGROUND: There is still no consensus on screening, threshold levels and treatment of gestational diabetes mellitus. Furthermore, the importance of a positive 50-g glucose screening test in patients who had a negative 100-g oral glucose tolerance test remains controversial. We investigated the impact of the 50-g glucose screening test results on neonatal outcome in pregnant women with uncomplicated pregnancies, who had no risk factors according to ACOG criteria. PATIENTS AND METHODS: Three hundred eighty-six pregnant women with singleton pregnancies were prospectively screened with 50-g glucose challenge test between 24 and 28 weeks. If the test result was >140 mg/dl, a 100-g 3-hour oral glucose tolerance test was performed. Patients with a positive screening test, but not diagnosed as gestational diabetes mellitus constituted the study group, and patients with a negative screening test constituted the control group. Cesarean rates, neonatal birth weights and complications were compared between these groups. RESULTS: The cesarean delivery rates were not statistically different between the study and control groups (8.3% vs. 6.4%, P>0.05). The rates of macrosomic births were 10.0% in the study group, and 6.4% in the control group (P>0.05), but the mean birth weight (3451.67 +/- 355.70 g) in the study group was significantly higher than the mean birth weight (3296.29 +/- 365.14 g) in the control group (P=0.003). Neonatal hypoglycemia and hyperbilirubinemia was also encountered more often in babies of pregnant women with a positive 50-g glucose challenge test but negative 100-g glucose tolerance test. CONCLUSION: Because of similarities with gestational diabetes mellitus on the basis of perinatal outcomes, the non-diabetic pregnant women with 50-g glucose screen test result over 140 mg/dl but a negative 100-g OGTT should be followed closely.

Is stress urinary incontinence a familial condition?

BACKGROUND: Stress urinary incontinence (SUI) is a common problem of multifactorial origin. Some authors have claimed that it has a familial predisposition. This study was undertaken to investigate the prevalence of SUI among first-degree relatives of 154 women who had been operated on for this disorder and of 100 women without SUI. METHODS: This report is concerned with a questionnaire-based, case-control study. A total of 154 women who had undergone operations for SUI and 100 women who denied having SUI were included. A comparison was made of 413 first-degree relatives of incontinent women and 372 first-degree relatives of continent women according to the demographic characteristics, obstetric and gynecologic history and risk factors for SUI. The prevalence of SUI was investigated among the relatives. Furthermore, the characteristics of the women who had SUI operation were compared according to the continence state of their families. RESULTS: The prevalence of SUI was 71.4% among mothers and 24.6% among sisters of operated women compared with 40.3% among mothers and 11.6% among sisters of continent women (p < 0.05). Furthermore, the age at which symptoms began was significantly lower in the members of the 'incontinent families' (p < 0.001). CONCLUSIONS: The relatives of incontinent women displayed a higher prevalence of SUI than the relatives of continent women. Although this condition has a multifactorial origin, the familial aggregation of SUI and the appearance of symptoms at younger ages in women with a family history of SUI suggest that heredity may play a significant role.

The prevalence of stress urinary incontinence among women operated on for abdominal wall hernias.

The high co-occurrence of an abdominal wall hernia (AWH) and stress urinary incontinence (SUI) suggests that there is a common factor in the etiopathogenesis of these disorders in these patients.

Laparoscopic burch colposuspension: comparison of effectiveness of extraperitoneal and transperitoneal techniques.

OBJECTIVE: To compare the effectiveness of two different laparoscopic colposuspension procedures: extraperitoneal approach using mesh fixed with tacks, and transperitoneal approach using sutures. STUDY DESIGN: We conducted a retrospective study of all patients (n = 64) who had undergone two different techniques of laparoscopic Burch colposuspension without additional surgeries over a 6-year period. Thirty-six women underwent laparoscopic transperitoneal colposuspension with using nonabsorbable sutures (group A), whereas 28 women underwent laparoscopic extraperitoneal colposuspension with using mesh and preperitoneal balloon dissection technique (group B). Cure rate was assessed by simple cystometry with a cough stress test in the standing position. Both groups were compared with regard to cure rates, operative time, length of hospital stay, complications, estimated blood loss, and total hospital charges. RESULTS: The mean times to follow-up were 25.7 months in the group A and 27.3 months in the group B (P = 0.082). At last follow-up, 33 of 36 (91.7%) patients in the group A and 23 of 28 (82.1%) patients in the group B were continent (P = 0.22). The other results were as follows for group A and B, respectively: average duration of surgery, 58.1 compared with 46.8 min (P = 0.001); average hospital stay, 2.05 compared with 1.57 days (P = 0.02); the intraoperative complication rate, 8.3% compared with 7.1% (P = 0.62). The total hospital charges for the group B were found significantly higher (US dollars 2,234 versus US dollars 1,348, P = 0.001). CONCLUSION: Although we found higher cure rates in laparoscopic colposuspension with the transperitoneal approach using sutures than the extraperitoneal approach using mesh fixed with tacks, there was no statistically significant difference between the two procedures. In comparison with extraperitoneal mesh technique, lower cost is the superiority of the transperitoneal suture technique.

Uterine lipoleiomyoma containing metastatic breast carcinoma: a case with two unusual pathologies.

Uterine lipoleiomyoma is a rare benign tumor. Besides this, metastasis to this tumor from breast carcinoma is extremely rare without any case reported in the literature. We report one such case of metastatic carcinoma in uterine lipoleiomyoma from primary breast cancer.