Effect of interferon alpha-2b on endometrioma cells in vitro.

OBJECTIVE: To examine the effect of interferon alpha-2b on the growth of endometrioma cells and its effect on the DNA synthesis. METHODS: Cells from four separate endometrioma cell lines were seeded into six-well plates in M199 medium containing increasing levels of interferon alpha-2b: 0 (control), 50, 100, 500, 1000, and 2000 U/mL. All cells were counted on days 0, 3, 6, and 9 in quadruplicate, and the counts were averaged for each condition. A second experiment was run to demonstrate the effect of short-term exposure of interferon alpha-2b on the growth of endometrioma cells in culture. In a separate experiment, cells from two endometriomas were plated in quadruplicate to evaluate the DNA synthesis. On day 3, 1000 and 4000 U/mL of interferon alpha-2b were added and run simultaneously with control (0 U/mL) wells. 3H-thymidine was added to each condition for 24 and 48 hours' incubation. Cells were then harvested and counted in a scintillation counter to study the 3H-thymidine uptake. RESULTS: Interferon alpha-2b suppressed endometrioma cell growth in vitro. This effect increased with increasing concentrations of interferon alpha-2b (50-2000 U/mL) compared with the control (0 U/mL). The suppression of cell growth was statistically significant, but when interferon alpha-2b was removed from the culture cell growth increased. 3H-thymidine uptake by endometrioma cells decreased compared with the control after 24 and 48 hours for interferon alpha-2b concentrations of 1000 and 4000 U/mL, respectively. CONCLUSION: Interferon alpha-2b inhibits the growth and DNA synthesis of endometrioma cells in culture. This finding may have prospects for the treatment of endometriosis.

Uterine artery embolization: the role in obstetrics and gynecology.

OBJECTIVE: Evaluation of the studies for the use of uterine artery embolization in various conditions in both obstetrics and gynecology. DESIGN: Literature review. RESULTS: Uterine artery embolization was successful in controlling postpartum hemorrhage in 94.9% of the cases. It was effective in controlling the bleeding in 96% of cases with uterine arteriovenous malformations and in 100% of the cases with abdominal and cervical pregnancies. Recently, it has been introduced as a line of treatment for uterine fibroids. It controlled bleeding in 82-92% of cases, and lead to 20-64% reduction in size of fibroids. CONCLUSIONS: Uterine artery embolization is of significant value in treating certain hemorrhagic conditions in obstetrics and gynecology including postpartum hemorrhage, ectopic pregnancy, and arteriovenous malformations. Its use in treatment of uterine fibroids is new and needs more collaborative studies by gynecologists and intervention radiologists to evaluate issues related to necrosis of the tumor, sepsis, and the long-term effect on size and recurrence rate.

Frequency of etiological factors and cost effectiveness of the work up for patients with history of recurrent pregnancy loss.

OBJECTIVE: To assess the frequency of the etiological factors during the evaluation of patients with recurrent abortions. The cost effectiveness of the most frequent positive findings will be assessed. STUDY DESIGN: This is a retrospective study in which 97 patient charts were evaluated and only 90 charts were included in this study. The diagnostic studies for every patient including hysterosalpingogram, endometrial biopsy, cervical cultures for Chlamydia and ureaplasma, and chromosomal karyotyping for the couple were assessed. The cost analysis was based on the CPT coding for each test. RESULTS: The frequency of the tests with highest positive findings were hysterosalpingogram, endometrial biopsy, cervical cultures, and immunologic studies. Chromosomal karyotyping has a low positive yield in evaluation of these patients. CONCLUSION: In evaluating patients with recurrent miscarriages, treating physicians should take into consideration the tests which have a high positive yield as a first step. Chromosomal karyotyping should be evaluated in specific situations.

Maintenance of increased Bcl-2 expression in uterine leiomyomas after GnRH agonist therapy.

OBJECTIVE: To compare the immunohistochemical expression of Bcl-2 in uterine leiomyomas in patients undergoing myomectomy or hysterectomy with and without preoperative treatment with the gonadotropin-releasing hormone receptor agonist (GnRH-a) leuprolide acetate (LA). STUDY DESIGN: Retrospective case-control study. Seventeen patients with symptomatic uterine leiomyomata were included. Of the 17 patients, 7 were treated with LA (3.75 mg) in three monthly doses prior to myomectomy or hysterectomy. Ten patients who did not receive LA and underwent hysterectomy for leiomyomas served as controls. Formalin-fixed, paraffin-embedded archival tissue from 17 leiomyomas were immunostained with a monoclonal antibody against Bcl-2 protein. Positivity was scored semiquantitatively on a three-tier scale. RESULTS: Immunostaining for Bcl-2 protein was intense (2-3+) in 7 LA-treated and 10 untreated leiomyomas but was scarce (0-1+) in normal myometrial smooth muscle. CONCLUSION: Abundant expression of Bcl-2 protein may be responsible for the growth of leiomyomas by preventing apoptotic cell death. Its increased expression is maintained in GnRH-a-treated leiomyomas.

Effects of chocolate cyst fluid on endometrioma cell growth in culture.

OBJECTIVE: To evaluate the effect of chocolate cyst fluid on the proliferation of cultured human endometrioma cells and to assay the concentration of transforming growth factor-B1 in this fluid. DESIGN: Controlled in vitro study. SETTING: Department of Obstetrics and Gynecology, State University of New York Health Science Center. PATIENT(S): Five women with ovarian endometriomas. INTERVENTION(S): Endometrioma tissue and chocolate fluid from five different patients were entered in this study. MAIN OUTCOME MEASURE(S): Endometrioma cell proliferation in culture with and without chocolate cyst fluid. RESULT(S): Chocolate cyst fluid increased the proliferation of endometrioma cells compared with controls. Also, high concentrations of transforming growth factor-B1 were found in cysts' fluid. CONCLUSIONS: Chocolate cyst fluid has a growth-enhancing effect on endometrioma cells. One promoting growth factor is transforming growth factor-B1.

Secondary amenorrhea with severe intrauterine adhesions and chronic uterine torsion after Cesarean section in a teenage girl.

This is a case of a 19-year-old patient who developed secondary amenorrhea after Cesarean section and severe postpartum hemorrhage. The pelvic examination revealed narrowing of the upper vagina and inaccessible cervix. Laparotomy revealed a dextrorotated uterus with massive intrauterine adhesions. All adhesions were excised with reconstruction of normal uterine anatomy. The patient regained normal menstrual cycles. There was no evidence of any endocrinopathies. According to a 10-year MEDLINE search of the literature, chronic torsion of the uterus after Cesarean section has not been previously described.

Congenital cervicovaginal aplasia with septate uterus and functioning endometrium.

A 14-year-old adolescent girl presented with primary amenorrhea and uncontrolled pelvic pain. Evaluation using pelvic sonogram, magnetic resonance imaging, and laparoscopy confirmed the diagnosis of cervicovaginal aplasia with functioning endometrium and a vaginal fistulous tract. At age 19 years, hysterectomy and vaginoplasty allowed the patient to be free of pain and to have normal sexual function.

The long-term effects of pregnancy and bromocriptine treatment on prolactinomas--the value of radiologic studies.

OBJECTIVE: To evaluate the long-term effects of pregnancy and bromocriptine treatment on prolactin-secreting pituitary tumors in women undergoing infertility treatment for prolactinomas. METHODS: The records of 17 patients with prolactinomas were reviewed. Data regarding age, prepregnancy baseline and postpartum serum prolactin levels, and radiologic studies including CT or MRI were assessed. 16 patients were treated with bromocriptine before achieving pregnancy. Bromocriptine therapy was resumed after delivery for the duration of 1 to 14 years. RESULTS: 45% of pregnancies did not affect the size of prolactinomas, 27% of pregnancies showed a decrease in size of prolactinomas or radiologic evidence of resolution of the tumor and 27% of pregnancies demonstrated radiologic increase in the size of prolactinomas. CONCLUSIONS: It is safe for patients with prolactinomas to achieve pregnancy following bromocriptine treatment. Pregnancy may lead to a slight decrease in the size of prolactinomas, increase in size, no change, and in some cases, complete resolution. There were no visual field changes during the pregnancies. Pregnancy and long-term bromocriptine treatment may be helpful in reduction of the size of the tumor.

Cumulative pregnancy rates and probability of pregnancy in various indications for intrauterine insemination.

A total of 122 patients were evaluated in a retrospective study for the cumulative pregnancy rate after intrauterine insemination. The indications included idiopathic infertility, anovulation, male factor, poor postcoital test, endometriosis, and pelvic factor. The cumulative pregnancy rate by 3 cycles or less varied from 7.7 to 43.5%. The highest pregnancy rate was for the group with poor postcoital test. There was no increase in pregnancy rate after 3 cycles of treatment. The concentration and motility of sperm were not significantly different between pregnant and nonpregnant groups.

The role of estradiol, progesterone, and transforming growth factor on human endometrioma cell culture.

The present study demonstrates several aspects of endometrioma cells in culture, namely, 1) cell growth, proliferation, and morphology, 2) effect of cell culture on estrogen and progesterone receptor concentration, 3) effect of estradiol, progesterone, and transforming growth factor. The tissue sample was obtained from ovarian endometriomas that were removed via laparotomy or laparoscopy. The tissue sample was digested with collagenase. After washing, the tissue was cultured in endothelial cell culture medium. Cell count was done by flow cytometry. Receptor study was done by immunohistochemistry. The results demonstrated the growth and proliferation of endometrioma cell in culture medium. Electron microscopy showed stroma-like cells. The cells lost their estrogen and progesterone receptors. Estradiol and progesterone added to these cultures did not affect the rate of growth and proliferation of the cells. Transforming growth factor significantly increased the rate of growth and proliferation of these cells.

Laparoscopic resection of an ovarian pregnancy in a patient using the copper T intrauterine device.

This is a case report of a 40-year-old multiparous woman with a right ovarian pregnancy. The patient has had a copper T intrauterine device for about 6 years. The diagnosis of ovarian pregnancy was based on the improper rise of serum beta-hCG levels, sonographic findings of an empty uterus, and the laparoscopic verification of Spiegelberg's criteria. The treatment was by laparoscopic resection of part of the right ovary with the pregnancy. Pathological examination confirmed the presence of ovarian tissue around the chorionic villi. The relationship between the use of the intrauterine device and ovarian pregnancy is discussed.

Supernumerary ovary with an endometrioma and osseous metaplasia: a case report.

A 32-year-old-woman with a history of endometriosis and chronic pelvic pain had left-sided pain and ultrasonographic documentation of a left pelvic complex cyst approximately 5 cm in diameter. Laparotomy revealed a left retroperitoneal cystic mass adjacent to the iliopsoas muscle and overlying the major pelvic vessels. The mass was dissected and excised. Histopathologic study revealed endometrioma and osseous metaplasia in a supernumerary ovary.

Evisceration after laparoscopic sterilization.

A 35-year-old multiparous woman underwent laparoscopic tubal sterilization without intraoperative problems. Postoperatively, she had nausea and vomiting that failed to respond to antiemetics. The cannula incision site was soaked with serosanguineous discharge. Exploration of the wound revealed evisceration of 10 cm of necrotic small bowel. Resection anastomosis was performed and the patient recovered uneventfully.

Computer-aided semen analysis variables as predictors of male fertility potential.

A computer-aided semen analysis (CASA) was used to allow digitizing the motion of the spermatozoon. This procedure allows an objective means of judging semen quality, especially the translational movements of spermatozoa. Forty-three couples were included in the study. The average age of the male was 35.5 +/- 4.7 years and that of the female was 32.7 +/- 4.7 years. The average duration of infertility was 3.8 +/- 2.3 years. Using multiple linear regression analysis of 26 prognostic variables, a cluster of 8 variables significantly predicted pregnancy maximally. The 8 variables and the resultant multiple correlation coefficients were used to generate a multiple regression equation which allowed the correct separation of the population into fertile and infertile couples. The mean pregnancy predictor values of the fertile and infertile populations were significantly different using the analysis of variance.

Congenital hypopituitarism as part of suprasellar dysplasia. A case report.

Congenital hypopituitarism may be due to hypothalamic failure. The case presented below belonged to this category. In addition, the demonstration of absent septum pellucidum placed this case in the category of suprasellar dysplasia. The patient was 21 years old, with primary amenorrhea and lack of development of secondary sex characteristics. The laboratory findings confirmed the diagnosis of hypothyroidism, hypocortisolism, hypogonadotropism, hyperprolactinemia and normal growth hormone. Stimulation studies revealed a subnormal response of cortisol to adrenocorticotrophic hormone stimulation, subnormal response of follicle stimulating hormone and luteinizing hormone to gonadotropin releasing hormone stimulation, normal response of prolactin to thyrotropin releasing hormone stimulation and exaggerated response of thyroid stimulating hormone to thyrotropin releasing hormone stimulation. The patient was treated with thyroid supplementation. Magnetic resonance imaging showed a hypoplastic infundibulum, ectopic neurohypophysis, small anterior pituitary gland and absent septum pellucidum. Congenital hypopituitarism may be part of a large spectrum of midline brain abnormalities.

Hyalinization and cellular changes in uterine leiomyomata after gonadotropin releasing hormone agonist therapy.

This study evaluated the microscopic changes in leiomyomata following the use of a gonadotropin releasing hormone (GnRH) agonist. Seventeen women with symptomatic leiomyomata were included. Nine were treated with a GnRH agonist for three to six months prior to surgery, and the remaining eight served as controls. Following myomectomy, paraffin sections were prepared from the tumors. These sections were examined microscopically by two gynecologic pathologists, who were blind to the patient groups. The results showed increased cellularity and hyalinization in leiomyomata following GnRH agonist treatment.

The effect of CO2 laser laparoscopy for treatment of pelvic endometriosis on serum concentrations of antiendometrial antibodies.

This study uses antiendometrial antibodies as an indicator for follow-up of patients with endometriosis after surgical treatment. This is a prospective study of 32 patients with endometriosis. The patients were used as their own controls. Serum samples were obtained before surgery and 1 month, 3 months, and 6-9 months following surgery. All patients were treated with CO2 laser laparoscopy. Serum concentrations of antiendometrial antibodies decreased significantly at 1 month, 3 months, and 6-9 months following treatment in each group. There was no correlation between baseline concentration of antibodies and stage of the disease. This study confirms the value of using antiendometrial antibodies as an indicator for follow-up of endometriosis patients. Surgical treatment with CO2 laser laparoscopy is effective in lowering the antigenic effect of the disease in these patients. This beneficial effect is maintained for up to 9 months after treatment.

Endometrial adenocarcinoma without prior hormone replacement in a diabetic patient with gonadal dysgenesis.

Patients with dysgenetic gonads and Turner syndrome are unlikely to develop endometrial carcinoma unless they have received unopposed estrogen replacement therapy. This case describes a 54-year-old woman with Turner syndrome and primary amenorrhea who developed adenocarcinoma of the endometrium without having received hormone replacement. Vaginal bleeding, a pelvic mass, and sepsis were the presenting symptoms. The patient also had diabetes mellitus and hypothyroidism. Polyglandular endocrine patterns are known to occur with a high frequency in these patients. The woman's chromosome studies revealed a modified 46,X,i(Xq) (isochromosome X). This is the first report of an isochromosome X patient to develop endometrial cancer without receiving estrogen replacement. The etiology of this rare case may be an increased propensity for patients with X-chromosome deletions to develop neoplasms in general, or extragonadal estrogen production.

Pathophysiology of pelvic adhesions. Modern trends in preventing infertility.

Infertility is secondary to pelvic adhesions in 15-20% of cases. Pelvic adhesions result from pelvic inflammatory disease, previous pelvic surgery, foreign bodies and previous appendicitis with pelvic abscess. As a result of the insult to the peritoneal surfaces of the pelvic organs, the concentrations of peritoneal fluid leukotriene, B4 and prostaglandin E2 are increased. Also, there is a decrease in plasminogen activity. The end result will be the formation of fibrin deposits, which will end in the formation of pelvic adhesions. The diagnosis of adhesions can be achieved by a high index of suspicion in patients with a history of pelvic infections or surgery. A pelvic examination with fixation of the uterus and/or adnexa is also highly suggestive. A hysterosalpingogram might lead to a suspicion of the presence of pelvic adhesions; however, there is some degree of false-positive and -negative results. The definitive diagnosis depends on laparoscopy. The use of an internationally accepted classification, such as that of the American Fertility Society, allows investigators to compare the results of treatment. Various adjuvants have been used following lysis of adhesions to prevent their recurrence; they yield various results. The most significant recommendation is to prevent the occurrence of adhesions by following the principles of microsurgical technique during every surgical procedure.